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Breastfeeding Hospital Initiative, Community-based participatory approach, Health disparities, Implementation evaluation, Baby-Friendly Hospital.



  1. VanDevanter, Nancy DrPH, RN, FAAN
  2. Gennaro, Susan PhD, RN, FAAN
  3. Budin, Wendy PhD, RN, FAAN
  4. Calalang-Javiera, Helene MSN, RNC-OB, IBCLC, RLC
  5. Nguyen, Minh BSN, RN


Purpose: The study evaluates the implementation of a United Nations Children's Fund (UNICEF)/WHO Baby-Friendly Hospital Initiative (BFHI) in a large urban hospital in New York City that serves primarily poor, minority women.


Study Design and Methods: A descriptive qualitative evaluation study that included focus groups, key informant interviews, and observations of the clinical environment was conducted using a community-based participatory research approach with healthcare providers.


Results: Findings revealed strengths and challenges in the implementation process at the system, provider, and patient levels. Strategies for enhancing program implementation and outcomes include expansion of provider education, development of additional patient interventions, enhancement of environmental structural supports, and continuation and expansion of program evaluation activities.


Clinical Implications: Evaluation of program implementation at multiple levels of the organization in collaboration with providers is critical to understanding program outcomes.