A Cattaneo1, R Buzzetti. 1. Unit for Health Services Research and International Cooperation, Istituto per l'Infanzia, Via dell'Lstria 65/1 34137 Trieste, Italy. cattaneo@burlo.trieste.it
Abstract
PROBLEM: Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere. Training of staff is necessary, but its effectiveness needs assessment. CONTEXT: Eight hospitals in different regions of Italy. DESIGN: Controlled, non-randomised study. Data collected in three phases. Training after the first phase in group 1 hospitals and after the second phase in group 2. STRATEGIES FOR CHANGE: Training of trainers and subsequent training of health workers with a slightly adapted version of the 18 hour Unicef course on breastfeeding management and promotion. KEY MEASURES FOR IMPROVEMENT: Hospital practices, knowledge of 571 health workers, and breastfeeding rates at discharge, three, and six months in 2669 mother and baby pairs. EFFECTS OF CHANGE: After training hospitals improved their compliance with the "ten steps to successful breast feeding," from an average of 2.4 steps at phase one to 7.7 at phase three. Knowledge scores of health professionals increased from 0.41 to 0.72 in group 1 (training after phase one) and from 0.53 to 0.75 in group 2 (after phase two). The rate of exclusive breast feeding at discharge increased significantly after training: 41% to 77% in group 1 and 23% to 73% in group 2, as did the rates of full (exclusive plus predominant) breast feeding at three months (37% to 50% in group 1 v 40% to 59% in group 2) and any breast feeding at six months (43% to 62% in group 1 v 41% to 64% in group 2). LESSONS LEARNT: Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.
PROBLEM: Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere. Training of staff is necessary, but its effectiveness needs assessment. CONTEXT: Eight hospitals in different regions of Italy. DESIGN: Controlled, non-randomised study. Data collected in three phases. Training after the first phase in group 1 hospitals and after the second phase in group 2. STRATEGIES FOR CHANGE: Training of trainers and subsequent training of health workers with a slightly adapted version of the 18 hour Unicef course on breastfeeding management and promotion. KEY MEASURES FOR IMPROVEMENT: Hospital practices, knowledge of 571 health workers, and breastfeeding rates at discharge, three, and six months in 2669 mother and baby pairs. EFFECTS OF CHANGE: After training hospitals improved their compliance with the "ten steps to successful breast feeding," from an average of 2.4 steps at phase one to 7.7 at phase three. Knowledge scores of health professionals increased from 0.41 to 0.72 in group 1 (training after phase one) and from 0.53 to 0.75 in group 2 (after phase two). The rate of exclusive breast feeding at discharge increased significantly after training: 41% to 77% in group 1 and 23% to 73% in group 2, as did the rates of full (exclusive plus predominant) breast feeding at three months (37% to 50% in group 1 v 40% to 59% in group 2) and any breast feeding at six months (43% to 62% in group 1 v 41% to 64% in group 2). LESSONS LEARNT: Training for at least three days with a course including practical sessions and counselling skills is effective in changing hospital practices, knowledge of health workers, and breastfeeding rates.
Authors: M S Kramer; B Chalmers; E D Hodnett; Z Sevkovskaya; I Dzikovich; S Shapiro; J P Collet; I Vanilovich; I Mezen; T Ducruet; G Shishko; V Zubovich; D Mknuik; E Gluchanina; V Dombrovskiy; A Ustinovitch; T Kot; N Bogdanovich; L Ovchinikova; E Helsing Journal: JAMA Date: 2001 Jan 24-31 Impact factor: 56.272
Authors: Harry Campbell; Trevor Duke; Martin Weber; Mike English; Susanne Carai; Giorgio Tamburlini Journal: Pediatrics Date: 2008-04 Impact factor: 7.124