Table 5 Components of Burke-Litwin model (1992), related findings, and recommendations to facilitate uptake and implementation of the BFHI

1. External environment

1.1 Influence of infant formula industry via their formula promotion advertising

1.2 Influence of societal attitudes

1.3 Influence of social media

● Minimising the impact of formula promotion on mothers, families, and communities

● Ensuring that formula industry act responsibly within social media context

● Improving public support of breastfeeding by improving societal knowledge and acceptance of breastfeeding

● Improving the breastfeeding messages on social media

2. Leadership support

2.1 Government support and intervention

2.2 Policy support and implementation to facilitate uptake and implementation of the BFHI

2.3 Organisational leadership to facilitate uptake and implementation of the BFHI

● Government intervention to promote the BFHI

● Establishment of supportive policies to facilitate uptake and implementation of the BFHI

● Evaluating and improving current policies and guidelines

● Strengthening the WHO Code implementation by legislation

● Develop and engage credible leadership to implement change

● Providing adequate and essential resources

3. Mission and strategies

3.1 Setting strategies to achieve the BFHI accreditation

3.2 Setting strategies to maintain reaccreditation

3.3 Establishment of plans to check feedbacks to ensure maintenance of Ten Steps

● Increasing number of accredited facilities

● Prioritising facilities with lower than optimum breastfeeding rates (e.g. initiation rate) for potential BFHI accreditation

● Prioritising facilities where best standard (Ten Steps) are not well established and/or practiced for potential BFHI accreditation

● Checking feedback from health professionals, stakeholders, and consumers

4. Organisation culture

4.1 Organisational culture support of the BFHI uptake and implementation

● Organisational cultural change -changing attitudes and practices-might be essential to implement the BFHI

● Staff attitudes towards breastfeeding must align with the BFHI standards

5. Management practices

5.1 Supportive management to implement the BFHI

● Develop and engage reliable and supportive management

● Managers must support staff to implement the BFHI by allocating required resources (e.g. free available educational materials) within facilities

6. Systems

6.1 Promotion of multidisciplinary team involvement

6.2 Establishment of an interdisciplinary team approach

6.3 Improvement in referral systems

● Establishing strategies to harmonize involvement among professional groups towards BFHI

● Improving inter professional collaboration

● Ensuring the referral of mothers to supportive breastfeeding groups post discharge to ensure continuous care

7. Structure

7.1 Continuous monitoring of the BFHI

7.2 Implementing structural change within related facilities to improve care

7.3 Implementing structural change in models of care to improve care

● Establishment of formal organisational structures to evaluate and/or monitor implementation of the BFHI

● Establishment and promotion of breast-milk banks within maternity facilities

● Promotion of continuous midwifery models of care

8. Work unit climate

8.1 Improving communication and/or interaction skills between healthcare staff and mothers

● Providing a continuous relationship between mothers and staff during the care period

● Improving communication skills between healthcare staff and mothers

● Improving interaction skills between healthcare staff and mothers

9. Motivation

9.1 Motivating organisations and/or individuals to facilitate uptake and implementation of the BFHI

● Reinforcing the public health impacts of the BFHI to motivate individuals and organisations

● Using motivating agents to ensure forward movement with the BFHI implementation

10. Task requirements and individual skills/abilities

10.1 Improving breastfeeding and BFHI related knowledge amongst staff, mothers, family members, and community

● Educating staff about the benefits of the Ten Steps

● Establishment of compulsory breastfeeding training programs for staff

● Providing up to dated and easily accessible training resources for staff

11. Individual needs and values

11.1 Addressing mothers’ needs and values

11.2 Addressing staff’s needs and values

● Addressing cultural differences in BFHI guidelines

● Providing culturally appropriate compassionate care for mothers

● Identifying staff needs to provide resources accordingly

12. Individual and organisational performance

12.1 Successful uptake and/or implementation of the BFHI

● Achieving successful uptake of the BFHI

● Achieving successful implementation of the BFHI