Implementing a breastfeeding literacy-promoting hospital program under the baby-friendly hospital initiative in...

To evaluate the implementation of a Breastfeeding Literacy-Promoting Hospital project following policy implementation and to explore stakeholders' experiences and perceptions, as well as factors influencing implementation, using the Consolidated Framework for Implementation Research (CFIR).

A qualitative study was conducted using in-depth interviews with 21 healthcare providers from 10 model hospitals across Thailand, selected through purposive sampling. Data were analyzed using thematic analysis guided by the CFIR framework to understand factors at the policy, organizational, and individual levels influencing implementation. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline.

The findings indicate that policy implementation is a system-level transformation process. Six key themes were identified: (1) the project enhanced clarity and systematization of existing practices; (2) the presence of tools and indicators facilitated the translation of policy into practice; (3) external factors, including policy context, referral systems, and family environment, remained significant constraints; (4) organizational readiness, particularly team structure and workforce capacity, influenced implementation success; (5) leadership and staff attitudes served as key driving forces; and (6) implementation required continuous processes of communication and monitoring.

Scaling up the breastfeeding literacy-promoting hospital project requires a multi-level implementation strategy encompassing intervention, organizational, and external system levels to ensure sustainability. Emphasis should be placed on designing integrated support systems rather than focusing on isolated interventions.