Factors affecting the implementation of effective interventions to support women to breastfeed: a systematic review and mixed methods synthesis

Background: Existing evidence suggests that when standalone breastfeeding support interventions are offered to women who choose to breastfeed, the duration and exclusivity of breastfeeding are likely to be increased (Gavine et al., 2022). However, many women in the UK and elsewhere continue to report that lack of adequate breastfeeding support results in them stopping breastfeeding earlier than planned. Therefore, one key research question is now to identify how known effective interventions can successfully be implemented in practice.

As part of the of the Action4Breastfeeding study, this review aimed to synthesise existing evidence on factors affecting the implementation of effective interventions identified in the updated Cochrane review on breastfeeding support for healthy women with healthy term babies (Gavine et al., 2022).

Methods: We systematically searched six bibliographic databases. Citation and reference searches of outcome papers from known effective interventions were also undertaken. No restrictions were applied on publication date and language. Articles reporting relevant qualitative and/or quantitative research were included. Quality appraisal was undertaken following study selection. Qualitative data were synthesised thematically (Thomas & Harden, 2008), and quantitative data narratively (Popay et al., 2006). A cross-study synthesis (Kavanagh et al., 2012) integrated qualitative and quantitative findings.

Findings: Sixteen articles were included in the final synthesis. A range of eighteen factors affecting the implementation of effective interventions were identified and grouped around five broad types of implementation factors. The types of factors with a more widespread evidence base were related to the implementation process (particularly those relating to the ability to monitor and collect quantitative and qualitative feedback about the progress and quality of implementation) followed by those relating to the external context of the implementing organisation (particularly in terms of the organisation's knowledge of their women's/families’ breastfeeding support needs).

Conclusion: Available evidence on the range of factors known to have impacted implementation of effective breastfeeding support interventions can inform guidance for organisations to develop robust implementation strategies which may be more likely to ensure successful implementation of evidence into practice.