Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach

Ruzafa Martinez, Maria; Ramos Morcillo, Antonio Jesús; Harillo Acevedo, Francisco David

Publication:
Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach

dc.contributor.author	Ruzafa Martinez, Maria
dc.contributor.author	Ramos Morcillo, Antonio Jesús
dc.contributor.author	Harillo Acevedo, Francisco David
dc.contributor.department	Enfermería
dc.date.accessioned	2024-01-28T11:49:56Z
dc.date.available	2024-01-28T11:49:56Z
dc.date.issued	2021-05
dc.description	©2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Accepted, version of a Published Work that appeared in final form in Journal of Nursing Scholarship. To access the final edited and published work see https://doi.org/10.1111/jnu.12636	es
dc.description.abstract	Background: Current literature provides poor information about the implementation of health-promoting clinical practice guidelines (CPGs) and their longitudinal monitoring. Purpose: The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs. Design: A mixed-methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach. Methods: The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre-implementation year (2011), 3 years of implementation (2012-2014), and 2 years of post-implementation (2015-2016). The sample was composed of mother-infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis. Findings: In the 6 years of monitoring, 7,842 mother-infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12-1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95-3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06-1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17). Conclusions: The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave-shaped dynamic. Clinical relevance: Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.	es
dc.format	application/pdf	es
dc.format.extent	37	es
dc.identifier.citation	Journal of Nursing Scholarship. 2021 May 53(3):358-368
dc.identifier.doi	https://doi.org/10.1111/jnu.12636
dc.identifier.issn	1547-5069
dc.identifier.issn	1527-6546
dc.identifier.uri	http://hdl.handle.net/10201/137848
dc.language	eng	es
dc.relation	Foundation for Healthcare Training and Research of the Murcia Region (FFIS), Grant FFIS/CE/02.	es
dc.rights	info:eu-repo/semantics/openAccess	es
dc.rights	Attribution-NonCommercial-NoDerivatives 4.0 Internacional	*
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/4.0/	*
dc.subject	Breastfeeding	es
dc.subject	Complex interventions	es
dc.subject	Guidelines	es
dc.subject	Implementation	es
dc.subject	Implementation planning	es
dc.subject	Implementation science	es
dc.subject	Implementation strategies	es
dc.subject	Time series	es
dc.title	Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach	es
dc.type	info:eu-repo/semantics/article	es
dspace.entity.type	Publication	es
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