'It seems like common sense now': experiences of allied health clinicians participating in a knowledge translation telementoring program.

INTRODUCTION AND AIMS: Clinicians understanding and applying the skills of knowledge translation is essential for the delivery of high value, effective health care. However, many clinicians lack confidence and capacity to undertake knowledge translation. Our team recently piloted a group telementoring knowledge translation support service (KTSS) with allied health professionals (AHPs) undertaking knowledge translation in their practice. This article aims to investigate barriers and enablers to participants' participation and identify evidence-based strategies to improve future delivery of the initiative. METHODS: The evaluation utilized semistructured interviews with participants who completed the first KTSS. Interview transcripts were analysed to identify key themes and subthemes. Subthemes were also mapped to an implementation science framework and model (theoretical domains framework and behaviour change wheel) to guide evidence-based identification of effective strategies to address, overcome, or enhance issues raised. RESULTS: Six of the nine participants invited were interviewed. Five barriers and six enablers of KTSS participation, and five improvement ideas for a future KTSS program, were suggested. Barriers included knowledge gaps, competing time demands, and organizational expectations. Enablers included organizational support, motivation and preparation, and local champions. Additional strategies included additional preparation, an initial rapport building session, and strategies to meet the emotional needs of the participants. These were reinforced by the framework mapping results, with the further addition of a peer modelling strategy. CONCLUSION: Through a qualitative methodology we have examined and identified the experiences of AHPs who have participated in a knowledge translation telementoring program with clear strategies to enhance further programs offered.

Implementing a best-practice model of gestational diabetes mellitus care in dietetics: a qualitative study.

BACKGROUND: Translating research into clinical practice is challenging for health services. Emerging approaches in implementation science recognise the need for a theory-driven approach to identify and overcome barriers to guideline adherence. However, many clinicians do not have the capacity, confidence, or expertise to realise change in their local settings. Recently, two regional sites participated in a facilitated implementation project of an evidence-based model of gestational diabetes mellitus (GDM) care in dietetics, supported by a team at a metropolitan centre. This study describes (i) stakeholder experiences', and (ii) learnings to inform implementation of the model of care (MOC) across Queensland. METHODS: This qualitative descriptive study utilised semi-structured telephone interviews with staff involved in implementation of the MOC project at two regional sites. Eight participants were recruited; five participants were from one site. Interviews were transcribed and analysed to identify recurrent themes. RESULTS: Four main themes were derived: (1) catalyst for positive change, (2) managing project logistics, (3) overcoming barriers, and (4) achieving change. CONCLUSIONS: A model of external facilitated implementation using an evidence-based decision making tool is an effective method of fostering health service change and is acceptable to staff. Key elements of the facilitation were building confidence and capacity in local implementers, through regular contact, encouraging local networking, linking to higher management support and assessing and/or influencing workplace or organizational culture. However, the balance between delivering clinical care while participating in a service change project proved challenging to many participants.

Staff Satisfaction in the Functionalisation of Psychiatric In-patient Care.

In many UK mental health services, in-patient psychiatric care is being separated from community care by having dedicated in-patient medical team. We evaluated staff satisfaction in this functionalised in-patient care. A survey was conducted amongst multidisciplinary staff from various teams using a questionnaire survey. On an average 14.3% of staff returned a satisfactory response for functionalisation, 57.3% had unsatisfactory response and others were undecided or perceived no change. There was no difference in responses amongst age, gender and professional groups. Mean scores of all groups were within unsatisfactory domain; however community staff compared to in-patient staff and staff with more than 5 years of experience compared to those with 1-5 years of experience returned significantly more unsatisfactory responses regarding functionalisation. Many positive and negative aspects of functionalisation were raised. The results of this evaluation suggest the need for further studies on the effectiveness of in-patient functionalisation. Short and long term clinical outcomes and the satisfaction of the patients should also be studied.

Strategies for success: a toolbox of coping strategies used by breastfeeding women.

AIMS: The purpose of this paper is to present the findings of two qualitative studies which identified strategies used by breastfeeding women to assist them to continue breastfeeding. BACKGROUND: While breastfeeding initiation rates are high in Australia, the majority of women wean before the recommended time. The identification of interventions which may increase breastfeeding duration is therefore a research priority. DESIGN: The Against All Odds study used a case-controlled design to investigate the characteristics of women who continued to breastfeed in the face of extraordinary difficulties. Phase One of the I Think I Can study employed the Nominal Group Technique to investigate the views of subject matter experts regarding which psychological factors may influence the duration of breastfeeding. METHOD: Against All Odds study participants (n = 40) undertook a one- to two-hour interview and the transcribed data were analysed using thematic analysis. Stratified purposeful sampling was employed in the I Think I Can study (n = 21), with participants assigned group membership according to their most recent breastfeeding experience. A fourth group was composed of experienced breastfeeding clinicians. The nominal group technique was used to generate group data and segments of the discussion were audiotaped and transcribed for thematic analysis. RESULTS: Participants in both the studies raised strategies used to assist them in their efforts to cope with the challenges of breastfeeding and early motherhood. These strategies included increasing breastfeeding knowledge, staying relaxed and 'looking after yourself', the use of positive self-talk, challenging unhelpful beliefs, problem solving, goal setting and the practice of mindfulness. CONCLUSIONS: Employment of these simple behavioural and cognitive strategies may assist women to cope with the pressures inherent in the experience of early mothering, thereby increasing the duration of breastfeeding. RELEVANCE TO CLINICAL PRACTICE: These results may represent a 'tool box' of coping strategies which can be provided to women for use in the postnatal period.

Necessity breeds innovation: GPs help prevent an emergency department closure.

In January 2006 the Maryborough Base Hospital in Queensland faced imminent closure of its emergency department (ED) due to a shortage of senior medical staff. At the same time patient confidence in Queensland Health was low. During consultation forums, the community had made it clear that their priority was to maintain emergency services in Maryborough. In search of a solution, the Fraser Coast District Health Service asked Maryborough general practitioners to work in the Maryborough Hospital ED and/or in the internal medicine ward as Visiting Medical Officers. While this represented a solution to the problem, there was much to be considered before such a plan could be put into place.

Exploring the influence of psychological factors on breastfeeding duration, phase 1: perceptions of mothers and clinicians.

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area.

The influence of psychological factors on breastfeeding duration.

AIM: This paper reports on a study examining the relationship between women's psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors. BACKGROUND: The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design. METHOD: Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview. FINDINGS: Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy. CONCLUSION: This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems.

AIMS: The study investigated factors empowering women to continue breastfeeding despite experiencing extraordinary difficulties. The study documented the experiences and characteristics of women who continued to breastfeed (continuing cohort) and those who weaned (non-continuing cohort) despite extraordinary difficulties. DESIGN: Retrospective case control. METHODS: The study was undertaken in south-east Queensland, Australia in 2004. Forty women (20 in each cohort) were recruited over six months. Both quantitative (breastfeeding knowledge questionnaire) and qualitative (semi-structured interviews) data were collected. This paper describes the qualitative data. RESULTS: Women from both cohorts expressed idealistic expectations about breastfeeding and experienced psychological distress due to their breastfeeding problems. Those who continued breastfeeding used coping strategies and exhibited personal qualities that assisted them to overcome the difficulties experienced. Women who continued to breastfeed were more likely to report relying on a health professional they could trust for support. This latter cohort were also more likely to report having peers with which they shared their experiences. Non-continuing women expressed feelings of guilt and inadequacy following weaning and were more likely to feel isolated. CONCLUSIONS: This study has highlighted the methods women use to deal with breastfeeding problems. It has also revealed modificable factors that can improve breastfeeding duration. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that clinicians should: *Provide information which accurately reflects the breastfeeding experience; *Ensure systems are in place so that effective postnatal support for breastfeeding difficulties is available; *Consider screening to ascertain levels of psychological distress, sadness and disillusionment among breastfeeding women; *Design educational interventions with elements of cognitive skills, problem-solving and self-efficacy training to equip women with the skills to overcome any experienced difficulties.

Identifying predictors of the reasons women give for choosing to breastfeed.

The aims of this article are to outline the reasons Australian women give for initiating breastfeeding, identify unique predictors for these reasons, and use principal components factor analysis to determine factors that influence a woman's decision to breastfeed. Data were collected as part of a large longitudinal study investigating the breastfeeding behaviors and supports of women in Southern Queensland, Australia. The most common reason women (N = 562) gave for deciding to breastfeed was breast milk is better for my baby (95.5%). Reasons related to the mother such as breastfeeding is more convenient (84.3%) were also popular. Four significant components-mother-related reasons, health effects for the infant, moral and family influences, and advice from others-were determined after principal components factor analysis. As well as health benefits for the infant, convenience and other reasons related to the mother appear to be important factors in an Australian woman's decision to breastfeed.

Creating a breastfeeding culture: a comparison of breastfeeding practises in Australia and Iran.

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants and has a unique biological and emotional influence on the health of both mother and child. However, despite the well documented health benefits of breastfeeding, most Australian women discontinue breastfeeding before the recommended time. This study attempts to identify variables influencing breastfeeding practices in Australia by comparing Australia with Iran, which enjoys a comparatively high breastfeeding rate. The study found a range of variables which appeared to negatively influence breastfeeding practices in Australia including: a comparatively inadequate national program for the promotion of breastfeeding; less uptake of the Baby Friendly Hospital Initiative; less supported return to paid work; and cultural issues.

An evaluation of a telephone-based postnatal support intervention for infant feeding in a regional Australian city.

BACKGROUND: Postnatal breastfeeding support in the form of home visits is difficult to accommodate in regional Australia, where hospitals often deal with harsh economic constraints in a context where they are required to provide services to geographically dispersed consumers. This study evaluated a predominantly telephone-based support service called the Infant Feeding Support Service. METHODS: A prospective cohort design was used to compare data for 696 women giving birth in two regional hospitals (one public, one private) and participating in the support service between January and July 2003 with data from a cohort of 625 women who gave birth in those hospitals before the introduction of the support service. Each mother participating in the support service was assigned a lactation consultant. First contact occurred 48 hours after discharge, and approximately weekly thereafter for 4 weeks. Breastfeeding duration was measured at 3 months postpartum. RESULTS: For women from the private hospital, the support service improved exclusive breastfeeding duration to 4.5 weeks postpartum, but these improvements were not evident at 3 months postpartum. No effects were observed for mothers from the public hospital. Quantitative and qualitative data demonstrated high levels of client satisfaction with the support service. CONCLUSIONS: This small-scale, predominantly telephone-based intervention provided significant, although apparently context-sensitive, improvements to exclusive breastfeeding duration.