title: A Community Health Clinic Breastfeeding-Friendly Pilot: What Can We Learn about the Policy Process?
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Washington Center for Public Health Nutrition, Seattle, WA, USA djohn@uw.edu.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Johnson
authors.affiliation: University of Washington Center for Public Health Nutrition, Seattle, WA, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Lamson
authors.affiliation: WithinReach, Seattle, WA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: WithinReach, Seattle, WA, USA.
authors.forename: Camie
authors.initials: C
authors.lastname: Goldhammer
authors.affiliation: Washington State Department of Health, Olympia, WA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Ellings
mesh_terms: D001942:Breast Feeding; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D006291:Health Policy; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D011181:Postnatal Care / Q000379:methods / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012944:Social Support; D014861:Washington
keywords: Ten Steps to Successful Breastfeeding; breastfeeding; breastfeeding practices; government policy; low-income women; nutrition policy; process evaluation; program evaluation