Using the Knowledge-to-Action Framework to understand experiences of breastfeeding guideline implementation: A qualitative study

J Nurs Manag. 2020 Oct;28(7):1670-1685. doi: 10.1111/jonm.13123. Epub 2020 Aug 30.

Abstract

Aim: To examine the perceptions and experiences of health care professionals and mothers in relation to the implementation of a breastfeeding clinical practice guideline (CPG).

Background: Breastfeeding CPG applications remain limited, and qualitative studies have indicated the need to overcome the perception by professionals of difficulties in applying recommendations.

Methods: A qualitative study was conducted in a Spanish public hospital that implemented the Registered Nurses´ Association of Ontario breastfeeding CPG from 2012 through 2015. Between May and August 2017, 27 semi-structured interviews were conducted with managers, with professionals in maternity and paediatric departments and with mothers. Deductive content analysis was performed following the stages in the Knowledge-To-Action (KTA) Framework.

Results: We obtained five main categories: (a) problem as opportunity; (b) adequate context and adapted recommendations; (c) extent of implementation; (d) impact of results; and (e) knowledge use normalization.

Conclusions: The KTA Framework assists understanding of the participation of the main actors in breastfeeding CPG implementation.

Implications for nursing management: The nature of the interventions and the participation of managers, different professionals and mothers in a multi-unit setting generate a complex implementation process that reveals key factors to be taken into account in future CPG implementations.

Keywords: breastfeeding; implementation science; midwifery; nursing; practice guideline; qualitative research.

MeSH terms

  • Breast Feeding*
  • Child
  • Female
  • Health Personnel
  • Humans
  • Mothers*
  • Ontario
  • Pregnancy
  • Qualitative Research