Evaluation methodology and design
Gau (2004): A 3-year quasi-experimental pre-post design study was conducted in 12 hospitals. The subjects were composed of 4614 lactating women in both experimental and control groups. The results indicated that the exclusive and overall breastfeeding rates of the experimental group were higher than those of the control group (p < 0.001); moreover, the breastfeeding rates generally exhibited an increasing trend year by year (p < 0.001). The results also showed that the experimental group scored higher in breastfeeding knowledge than the control group as did positive attitudes toward breastfeeding (t > 1.96, p < 0.05) with scores increasing year by year. The results also showed that higher scores reflected better knowledge in breastfeeding, and, in turn, a longer duration of breastfeeding.
Are there measures in place to assess fidelity?
There have been several studies of BFHI. These include a trial of 4,614 women which found that breastfeeding rates were higher where policies had been changed in line with the WHO BFHI initiative, with rates increasing each year (Perez-Escamilla et al., 1994). Other studies have suggested that the effectiveness is not maintained after the mother leaves the hospital (Couinho et al., 2005; Gau, 2004). In Australia, surveys have shown that some hospitals may not be using all 10 steps (Walsh, Pincombe and Stamp 2006; cited by DEECD).
Gau, M.L. (2004) Evaluation of a lactation intervention program to encourage breastfeeding: a longitudinal study. International Journal of Nursing Studies. 41(4), 425-35. http://dx.doi.org/10.1016/j.ijnurstu.2003.11.002.
Perez-Escamilla, R., Pollitt, E., Lonnerdal, B., & Dewey, K.G. (1994) Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview. American Journal of Public Health. 84, 89–97. www.ncbi.nlm.nih.gov/pmc/articles/PMC1614910/