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. 2025 Aug;41(3):423-433.
doi: 10.1177/08903344251337375. Epub 2025 May 27.

Cultural Interpretations of Patients and Employees in an Organization Certified Through the Baby-Friendly Hospital Initiative: A Focused Ethnographic Study

Keri Durocher  1 , Kimberley T Jackson  1 , Richard Booth  1 , Panagiota Tryphonopoulos  1
Affiliations

Cultural Interpretations of Patients and Employees in an Organization Certified Through the Baby-Friendly Hospital Initiative: A Focused Ethnographic Study

Keri Durocher et al. J Hum Lact. 2025 Aug.

Abstract

Background: When organizations are certified through the Baby-Friendly Hospital Initiative, health care providers implement various policies that are intended to support long-term and exclusive breastfeeding. Despite the availability of evidence to support these policies, research findings are inconsistent in whether these goals are met. Exploring cultural interpretations through the lens of individuals within these organizations may reveal new evidence of breastfeeding experiences and needed support.

Research aim: To explore organizational cultural aspects of a Baby-Friendly certified organization from the perspective of patients and employees.

Method: Researchers implemented a focused ethnography design in one certified organization in Ontario, Canada. One-to-one, semi-structured interviews were performed with two participant groups, including 10 patients and eight employees within intrapartum and postpartum care areas between 2023-2024. An inductive data analysis approach followed Roper and Shapira's framework, including (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generalizing with constructs and theories, and (5) memoing.

Results: Five core themes emerged from the data, including (1) knowledge is power, (2) community of support, (3) contextual considerations, (4) environment for breastfeeding, and (5) patient factors. Through narrative descriptions, these interrelated themes exhibit how patients and employees have experienced or provided care that is consistent with breastfeeding-supportive policies as well as additional gaps that may not be addressed through policy research.

Conclusion: The results provide implications for breastfeeding support within an organization certified through the Baby-Friendly Hospital Initiative. Understanding cultural interpretations of breastfeeding can provide information for future education and interprofessional development.

Keywords: Baby-Friendly Hospital Initiative; COVID-19; breastfeeding; breastfeeding experience; breastfeeding knowledge; breastfeeding practices; breastfeeding support; cultural norms; ethnography; health services research; postpartum care.

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Conflict of interest statement

Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KTJ was KD’s academic supervisor at Western University. RB and PT were on KD’s supervisory committee for her PhD research. The authors disclosed no other potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Organizational Culture Within a Baby-Friendly Hospital Initiative-Certified Setting.
See this image and copyright information in PMC

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