abstract: 'Background: Implementing evidence-based practices and policies for

  breastfeeding support in community clinics is a promising, but

  challenging, approach to reducing disparities in breastfeeding rates.

  Objective: This study aimed to apply a policy process research framework

  to increase knowledge of factors that facilitate adoption and

  implementation of breastfeeding policy changes.

  Methods: In 2013, Washington State piloted a process to encourage 8

  clinics to adopt and implement steps to become breastfeeding friendly.

  Evaluation data were collected through interviews, project reports,

  training evaluations, and pre- and post-self-assessments of achievement

  of the steps.

  Results: In 6 months, clinics increased the breastfeeding-friendly steps

  that they were implementing from a median (interquartile range) of 1.5

  (0-3) to 6 (5-7). Improvements were most likely in the steps that

  required the fewest resources and administrative changes. Barriers to

  implementation included misperceptions about breastfeeding and

  breastfeeding support; lack of administrative buy-in; need for

  organizational changes to accommodate actions like monitoring

  breastfeeding rates and allowing providers training time; and the

  social-political climate of the clinic. Several factors, including

  actions taken by public health practitioners, enhanced the change

  process. These included fostering supportive relationships, targeting

  technical assistance, and providing resources for planning and training.

  Conclusion: This pilot project demonstrates that it is possible to make

  changes in breastfeeding support practices and policies in community

  clinics. Recommendations to enhance future work include framing and

  marketing breastfeeding support in ways that resonate with clinic

  decision makers and enhancing training, resources, and advocacy to build

  capacity for internal and external systems changes to support

  breastfeeding best practices.'
affiliation: 'Johnson, DB (Corresponding Author), Univ Washington, Nutr Sci, Box 353410,
  Seattle, WA 98195 USA.

  Johnson, Donna B.; Lamson, Erica, Univ Washington, Ctr Publ Hlth Nutr, Seattle,
  WA 98195 USA.

  Schwartz, Rachel; Goldhammer, Camie, WithinReach, Seattle, WA USA.

  Ellings, Amy, Washington State Dept Hlth, Olympia, WA USA.'
author: Johnson, Donna B. and Lamson, Erica and Schwartz, Rachel and Goldhammer, Camie
  and Ellings, Amy
author-email: djohn@uw.edu
author_list:
- family: Johnson
  given: Donna B.
- family: Lamson
  given: Erica
- family: Schwartz
  given: Rachel
- family: Goldhammer
  given: Camie
- family: Ellings
  given: Amy
da: '2023-09-28'
doi: 10.1177/0890334415579656
eissn: 1552-5732
files: []
issn: 0890-3344
journal: JOURNAL OF HUMAN LACTATION
keywords: 'breastfeeding; breastfeeding practices; government policy; low-income

  women; nutrition policy; process evaluation; program evaluation; Ten

  Steps to Successful Breastfeeding'
keywords-plus: 10 STEPS; IMPLEMENTATION; ATTITUDES; SUPPORT; CARE; KNOWLEDGE
language: English
month: NOV
number: 4, SI
number-of-cited-references: '37'
pages: 660-670
papis_id: 40b779ffedcf1fa92ceb779b9ce1b5fb
ref: Johnson2015communityhealth
times-cited: '6'
title: 'A Community Health Clinic Breastfeeding-Friendly Pilot: What Can We Learn
  about the Policy Process?'
type: Article
unique-id: WOS:000362686100015
usage-count-last-180-days: '0'
usage-count-since-2013: '7'
volume: '31'
web-of-science-categories: Nursing; Obstetrics \& Gynecology; Pediatrics
year: '2015'