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The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.
Quasi-experimental research design.
The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.
A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.
In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.
Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.
What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.
What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.
Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.
This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.
No patient or public contribution.
This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.
No protocol.
Reliable detection of cigarette smoking is necessary for just-in-time adaptive smoking cessation support. Smoking detection typically relies on intervention recipients to self-report smoking behaviours and their antecedents, which is burdensome and subject to reporting biases, or on specialised sensors and wearables to detect smoking gestures, which may not be feasible for real-world implementation. Here, we describe an observational laboratory-based study protocol designed to identify signature biomarkers and hand–mouth gestures associated with presmoking, smoking and postsmoking using off-the-shelf wearable devices.
30 non-treatment seeking individuals who use combustible tobacco products will participate in the study. Participants will be monitored for 1 hour in a smoking chamber, during which time they will wear a Garmin device that will collect hand/arm movement, heart rate, heart rate variability, blood oxygenation and respiratory rate. First, participants will be in a nicotine-deprived state based on 12-hour abstinence validated by exhaled carbon monoxide readings (~20 min). Then, participants will be allowed to smoke cigarettes of their choice (~10–15 min). Finally, participants will be in a nicotine-satiated state (~25 min). Participants will be video recorded to allow us to label the data corresponding to the smoking stage and behaviour. We will conduct time-series analysis and analysis of variance to quantify changes in biomarkers between smoking stages.
The Institutional Review Board of the University of Kansas Medical Centre approved the study on 21/3/2025 (STUDY00161139). Participants will provide informed consent to participate in the study. Data collection is expected to begin in September 2025 and results will be submitted for publication in 2026.
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