a multisite, descriptive, qualitative study of eight hospitals that used semi-structured interviews of health-care professionals. Template analyses identified factors that related to organisation-level theory. Cross-site comparative analyses explored how factors varied across hospitals.
thirty-four health-care professionals from eight North Carolina hospitals serving low-wealth populations. The hospitals are participating in a quality improvement project to support the implementation of the Ten Steps. This study occurred during the pre-implementation phase.
several factors emerged relating to collective efficacy (i.e., the shared belief that the group, as a whole, is able to implement the Steps) and collective commitment (i.e., the shared belief that the group, as a whole, is committed to implementing the Steps) to implement the Ten Steps. Factors relating to both constructs included ¡®staff age/experience,¡¯ ¡®perceptions of forcing versus supporting mothers,¡¯ ¡®perceptions of mothers¡¯ culture,¡¯ and ¡®reliance on lactation consultants.¡¯ Factors relating to commitment included ¡®night versus day shift,¡¯ ¡®management support,¡¯ ¡®change champions,¡¯ ¡®observing mothers utilize breastfeeding support.¡¯ Factors relating to efficacy included ¡®staffing,¡¯ ¡®trainings,¡¯ and ¡®visitors in room.¡¯ Commitment-factors were more salient than efficacy-factors among the three large hospitals. Efficacy-factors were more salient than commitment-factors among the smaller hospitals.
interventions focused on implementing the Ten Step may benefit from improving collective efficacy and collective commitment. Potential approaches could include skills-based, hands-on training highlighting benefits for mothers, staff, and the hospital, and addressing context-specific misconceptions about the Steps.