title: [Breast-feeding training programme as intervention approach at the hospital level: results of evaluation of the first phase of the STELLA study].
abstract: BACKGROUND
  The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions.
  
  
  METHODS
  A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention.
  
  
  RESULTS
  Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each).
  
  
  CONCLUSIONS
  Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.
authors.affiliation: Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Sachbereich Arbeits- und Umweltepidemiologie, München. nicole.meyer@lgl.bayern.de
authors.forename: N
authors.initials: N
authors.lastname: Meyer
authors.forename: H
authors.initials: H
authors.lastname: Spegel
authors.forename: L
authors.initials: L
authors.lastname: Hendrowarsito
authors.forename: U
authors.initials: U
authors.lastname: Schwegler
authors.forename: H
authors.initials: H
authors.lastname: Fromme
authors.forename: G
authors.initials: G
authors.lastname: Bolte
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006293:Health Promotion / Q000706:statistics & numerical data*; D006771:Hospitals, Maternity / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000193:education*; D009035:Mothers / Q000193:education*; D055815:Young Adult