Assessing Readiness for Change: A Baseline Situational Analysis of Breastfeeding Support Within Acute and Community Healthcare Settings in the Republic of Ireland

Breastfeeding is a critical component of maternal and child health, but breastfeeding rates vary widely, with Ireland's rates lowest in Europe. This paper, the first stage of the Practice Enhancement for Exclusive Breastfeeding (PEEB) study, describes the methodology and key findings from a multi-component baseline situational analysis of breastfeeding support conducted in acute and community healthcare settings in Ireland. Guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, a survey of healthcare professionals (n = 85) examined breastfeeding training, competency and attitude towards practice change. Additionally, a workplace environment and policy assessment were conducted. A gap between current practices and evidence-based guidelines was demonstrated and the need for cultural shifts within healthcare settings towards better breastfeeding support. The study also uncovered notable variations in breastfeeding training, perceived barriers to effective breastfeeding support, including staff shortages and communication challenges, which impede successful implementation of breastfeeding initiatives. Despite high levels of staff motivation, there was a lack of empowerment and confidence to implement change. Findings revealed significant differences between community and acute staff across certain factors like community staff being less likely to agree that their teammates considered implementation of changes as futile, acute staff were less likely to disagree that changes would be subject to audit. The PARIHS framework provided a structured approach to understanding the evidence and contextual factors relevant to implementing evidence-based practices in breastfeeding support. Future work will focus on the design and implementation of strategies to optimise breastfeeding support across acute and community settings.