Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.

Aim: To examine the perceptions and experiences of health care professionals and mothers in relation to the implementation of a breastfeeding clinical practice guideline (CPG). Background: Breastfeeding CPG applications remain limited, and qualitative studies have indicated the need to overcome the perception by professionals of difficulties in applying recommendations. Methods: A qualitative study was conducted in a Spanish public hospital that implemented the Registered Nurses´ Association of Ontario breastfeeding CPG from 2012 through 2015. Between May and August 2017, 27 semi-structured interviews were conducted with managers, with professionals in maternity and paediatric departments and with mothers. Deductive content analysis was performed following the stages in the Knowledge-To-Action (KTA) Framework. Results: We obtained five main categories: (a) problem as opportunity; (b) adequate context and adapted recommendations; (c) extent of implementation; (d) impact of results; and (e) knowledge use normalization. Conclusions: The KTA Framework assists understanding of the participation of the main actors in breastfeeding CPG implementation. Implications for Nursing Management: The nature of the interventions and the participation of managers, different professionals and mothers in a multi-unit setting generate a complex implementation process that reveals key factors to be taken into account in future CPG implementations.

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

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.