Thesis (MPH.) -- University of Limpopo, 2022 / Background: The Mother baby friendly initiative (MBFI) is an initiative that was launched in 1991 as a global programme to create an environment that enables and supports women to breastfeed their infants, providing advice to mothers and practical assistance to promote breastfeeding. This initiative plays an important role in improving infant’s nutritional status, growth, development and health for both mother and infant and supports exclusive breastfeeding. MBFI aims at increasing breastfeeding rate by supporting, protecting and promoting breastfeeding in health facilities. Aim: of the study is to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at Standerton hospital. Method: A qualitative descriptive design was used to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at selected hospital. Purposive sampling of the healthcare providers were the target population for the study as they are responsible for the implementation of MBFI in the hospital. In this research, data collected were in a form of interviews, audiotapes and written notes from interviews. Tesch’s eight steps in data analysis was used to analyse data. Results: The studies key theme and sub theme give the study’s findings and perspective of the issues found. The studies key theme were: 1. Knowledge of participants on MBFI at Standerton hospital, 2. Views about current practices of MBFI at Standerton –hospital and 3. Challenges regarding MBFI implementation at Standerton. MBFI was considered significant in the facility, however, due to inconsistences and challenges faced by the nurses the initiative was not fully implemented to improve breastfeeding rates. Conclusion: the study conclude that nurse’s had some knowledge on the MBFI initiative as they understood their role in breastfeeding advocacy and enhancing maternal and child health. There were significant challenges in MBFI implementation such as shortage of staff, lack of resources and training that hindered MBFI compliance and mothers not receiving the full benefits of the initiative, which contribute to decreased breastfeeding rates within the facility.

Contexte : Pour favoriser l’allaitement, la Condition 3 de l’Initiative des amis des bébés (IAB) (OMS / UNICEF) vise à offrir une information complète aux femmes enceintes. Or, cette condition est implantée de façon variable dans les CLSC de Montréal car les intervenants de la santé ne semblent pas confortables à faire la promotion de l’allaitement en prénatal, surtout dans les milieux « québécois » et défavorisés. Objectif : Explorer les expériences personnelles et professionnelles des infirmières en santé communautaire qui sont reliées à la promotion de l’allaitement en prénatal en milieu défavorisé. Dans la présente étude, les informations moins souvent transmises, soit les risques du non-allaitement ainsi que la recommandation de poursuite de l’allaitement jusqu’à deux ans ou au-delà, ont été examinées. Méthodologie : La collecte des données de cette recherche qualitative s’est effectuée auprès d’infirmières de huit CLSC montréalais offrant des services à une population importante de femmes défavorisées, francophones, nées au Canada et ce, sous forme d’entrevues individuelles (n=12 infirmières) et d’entrevues de groupe (n=36 infirmières). Résultats : Les principaux facteurs favorables au niveau de confort des infirmières à faire la promotion de l’allaitement sont d’avoir suivi 20 heures ou plus de formation en allaitement dans les cinq dernières années, et d’avoir des croyances profondes positives quant à la valeur de l’allaitement comparativement aux préparations commerciales pour nourrissons (PCN). Craindre de susciter la culpabilité nuit à la promotion de l’allaitement. De plus, les infirmières exposées à la culture d’allaitement pendant l’enfance, ayant eu une expérience personnelle d’allaitement positive, qui perçoivent que leur rôle est d’encourager les mères à allaiter, ou qui recommandent rarement de donner des PCN en postnatal en cas de problèmes d’allaitement, sont plus confortables à informer les femmes enceintes des risques du non-allaitement. Conclusion : Plusieurs infirmières semblent manquer de connaissances sur la qualité supérieure de l’allaitement par rapport à l’alimentation artificielle et sur les risques du non-allaitement. De plus, il semble que plusieurs infirmières n’aient pas les habiletés cliniques optimales pour soutenir les mères dans leur allaitement. Des formations appropriées aideraient les infirmières à avoir davantage confiance dans leur capacité à soutenir les mères en postnatal, ainsi qu’à promouvoir l’allaitement en prénatal. Finalement, les infirmières devraient prendre conscience de leurs biais personnels, afin d’en réduire les impacts négatifs sur leur pratique professionnelle. / Background: In order to increase breastfeeding rates, the third Step of the Baby Friendly Initiative (BFI) (WHO / UNICEF) aims to offer complete information on breastfeeding to pregnant women. However, this step’s implementation varies among the Montreal’s CLSCs as healthcare professionals seem uncomfortable to promote breastfeeding prenatally, especially in French speaking and underprivileged areas. Objective: To explore the personal and professional experiences of community health nurses which are linked to the promotion of breastfeeding during the prenatal period in underprivileged areas. Information less often offered were examined in this study: the risks of not breastfeeding and the recommendation to continue breastfeeding up to 2 years or beyond. Methodology: The data of this qualitative study were collected in 8 CLSCs of Montreal, offering services to an important population of underprivileged women, French speaking and born in Canada, through nurses’ individual interviews (n=12 nurses) and group interviews (n=36 nurses). Results: The most important factors for the level of comfort of nurses to promote breastfeeding are: to have followed 20 hours or more of training on breastfeeding within the 5 past years, and to have positive profound beliefs about the value of breastfeeding compared to artificial infant formula (AIF). Fear of causing guilt by promoting breastfeeding hinders breastfeeding promotion. Furthermore, nurses exposed to breastfeeding culture during their childhood, with a positive personal breastfeeding experience, who perceived that their role is to support women to breastfeed, or those who rarely recommended mothers to give AIF postnatally in case of breastfeeding problems, are more comfortable to inform pregnant women about the risks of not breastfeeding. Conclusion: Many nurses seem to have a lack of knowledge about the superior quality of breastfeeding in comparison with artificial feeding and about the risks of not breastfeeding. Moreover, it seems that many nurses do not have the optimal clinical abilities to support mothers in their breastfeeding experience. Appropriate training could greatly help nurses to have greater confidence in their abilities to support mothers during the postnatal period, as well as to promote breastfeeding in the prenatal period. Finally, nurses should become aware of their personal bias, in order to reduce as much as possible negative impacts on their professional practices.

Contexte : Pour favoriser l’allaitement, la Condition 3 de l’Initiative des amis des bébés (IAB) (OMS / UNICEF) vise à offrir une information complète aux femmes enceintes. Or, cette condition est implantée de façon variable dans les CLSC de Montréal car les intervenants de la santé ne semblent pas confortables à faire la promotion de l’allaitement en prénatal, surtout dans les milieux « québécois » et défavorisés. Objectif : Explorer les expériences personnelles et professionnelles des infirmières en santé communautaire qui sont reliées à la promotion de l’allaitement en prénatal en milieu défavorisé. Dans la présente étude, les informations moins souvent transmises, soit les risques du non-allaitement ainsi que la recommandation de poursuite de l’allaitement jusqu’à deux ans ou au-delà, ont été examinées. Méthodologie : La collecte des données de cette recherche qualitative s’est effectuée auprès d’infirmières de huit CLSC montréalais offrant des services à une population importante de femmes défavorisées, francophones, nées au Canada et ce, sous forme d’entrevues individuelles (n=12 infirmières) et d’entrevues de groupe (n=36 infirmières). Résultats : Les principaux facteurs favorables au niveau de confort des infirmières à faire la promotion de l’allaitement sont d’avoir suivi 20 heures ou plus de formation en allaitement dans les cinq dernières années, et d’avoir des croyances profondes positives quant à la valeur de l’allaitement comparativement aux préparations commerciales pour nourrissons (PCN). Craindre de susciter la culpabilité nuit à la promotion de l’allaitement. De plus, les infirmières exposées à la culture d’allaitement pendant l’enfance, ayant eu une expérience personnelle d’allaitement positive, qui perçoivent que leur rôle est d’encourager les mères à allaiter, ou qui recommandent rarement de donner des PCN en postnatal en cas de problèmes d’allaitement, sont plus confortables à informer les femmes enceintes des risques du non-allaitement. Conclusion : Plusieurs infirmières semblent manquer de connaissances sur la qualité supérieure de l’allaitement par rapport à l’alimentation artificielle et sur les risques du non-allaitement. De plus, il semble que plusieurs infirmières n’aient pas les habiletés cliniques optimales pour soutenir les mères dans leur allaitement. Des formations appropriées aideraient les infirmières à avoir davantage confiance dans leur capacité à soutenir les mères en postnatal, ainsi qu’à promouvoir l’allaitement en prénatal. Finalement, les infirmières devraient prendre conscience de leurs biais personnels, afin d’en réduire les impacts négatifs sur leur pratique professionnelle. / Background: In order to increase breastfeeding rates, the third Step of the Baby Friendly Initiative (BFI) (WHO / UNICEF) aims to offer complete information on breastfeeding to pregnant women. However, this step’s implementation varies among the Montreal’s CLSCs as healthcare professionals seem uncomfortable to promote breastfeeding prenatally, especially in French speaking and underprivileged areas. Objective: To explore the personal and professional experiences of community health nurses which are linked to the promotion of breastfeeding during the prenatal period in underprivileged areas. Information less often offered were examined in this study: the risks of not breastfeeding and the recommendation to continue breastfeeding up to 2 years or beyond. Methodology: The data of this qualitative study were collected in 8 CLSCs of Montreal, offering services to an important population of underprivileged women, French speaking and born in Canada, through nurses’ individual interviews (n=12 nurses) and group interviews (n=36 nurses). Results: The most important factors for the level of comfort of nurses to promote breastfeeding are: to have followed 20 hours or more of training on breastfeeding within the 5 past years, and to have positive profound beliefs about the value of breastfeeding compared to artificial infant formula (AIF). Fear of causing guilt by promoting breastfeeding hinders breastfeeding promotion. Furthermore, nurses exposed to breastfeeding culture during their childhood, with a positive personal breastfeeding experience, who perceived that their role is to support women to breastfeed, or those who rarely recommended mothers to give AIF postnatally in case of breastfeeding problems, are more comfortable to inform pregnant women about the risks of not breastfeeding. Conclusion: Many nurses seem to have a lack of knowledge about the superior quality of breastfeeding in comparison with artificial feeding and about the risks of not breastfeeding. Moreover, it seems that many nurses do not have the optimal clinical abilities to support mothers in their breastfeeding experience. Appropriate training could greatly help nurses to have greater confidence in their abilities to support mothers during the postnatal period, as well as to promote breastfeeding in the prenatal period. Finally, nurses should become aware of their personal bias, in order to reduce as much as possible negative impacts on their professional practices.

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

Objective: To understand the use of evidence-informed decision-making within an interorganizational network, and identify the facilitators and barriers to achieving network goals. Design: Case study. Setting: Rural health district in Nova Scotia, Canada (2006 to 2011). Participants: Members from 4 organizations representing community and hospital groups participating in a regional Baby Friendly Initiative network. Methods: A descriptive mixed methods study using focus group and questionnaire methodology. Data were analyzed using framework analysis and social network analysis (SNA). Results: The SNA results highlighted the role that relationships have on the sharing of knowledge among network members. The findings highlight the need for leadership at multiple levels (community, network members, primary organizations, and the provincial government). A lack of resources to achieve the network’s goals was a key barrier. Conclusions: The role of multi-level leadership is important for future network development and community consideration. The case study methodology facilitated momentum towards the network’s goals.

The WHO Code of Marketing of Breast Milk Substitute is a public health recommendation to reduce preventable causes of infant morbidity and mortality associated with malnutrition. Irresponsible marketing of infant formula in hospitals is a threat to exclusive breastfeeding. Nurses are mandated to support, encourage and protect breastfeeding and to familiarize themselves with their responsibilities under this Code. The researcher explored Geneva nurses' knowledge of the Code and its impact in practice. Eighty seven point seven percent of the participating nurses had poor level of knowledge of the Code. Poor knowledge of the Code impacts on the quality and consistency of information given to mothers in hospitals. Inadvertent violations of the Code were observed among a minority of the respondents: 7.3% indicated that they received gifts; 2.4% received sponsorships to conferences. Training about the Code and its application in counseling is recommended to complement the babyfriendly initiative at hospitals to improve nutrition outcomes. / Health Studies / M.A. (Public Health)

The WHO Code of Marketing of Breast Milk Substitute is a public health recommendation to reduce preventable causes of infant morbidity and mortality associated with malnutrition. Irresponsible marketing of infant formula in hospitals is a threat to exclusive breastfeeding. Nurses are mandated to support, encourage and protect breastfeeding and to familiarize themselves with their responsibilities under this Code. The researcher explored Geneva nurses' knowledge of the Code and its impact in practice. Eighty seven point seven percent of the participating nurses had poor level of knowledge of the Code. Poor knowledge of the Code impacts on the quality and consistency of information given to mothers in hospitals. Inadvertent violations of the Code were observed among a minority of the respondents: 7.3% indicated that they received gifts; 2.4% received sponsorships to conferences. Training about the Code and its application in counseling is recommended to complement the babyfriendly initiative at hospitals to improve nutrition outcomes. / Health Studies / M.A. (Public Health)