Improving breastfeeding rates is one of the most cost-effective ways to prevent infant deaths, but most of the world falls far below WHO recommended breastfeeding practices. Confident, informed healthcare workers are an important resource to promote breastfeeding, but healthcare workers are at risk of early breastfeeding cessation themselves. Culture, ethnicity and socio-economic status impact breastfeeding rates with some of the highest and lowest rates in Southeast Asia reported from Thailand. This study explores the relationship between workplace determinants of breastfeeding, personal breastfeeding outcomes for healthcare workers, and the breastfeeding care healthcare workers provide their patients. This study used a sequential exploratory design guided by a conceptual framework based on social ecological/ecological psychology models. Participants came from four clinical sites in Northern Thailand, from ethnically Burman or Karen communities with high breastfeeding rates, and Thai communities with low breastfeeding rates. In-depth interviews (July 2020-November 2020) were followed by a quantitative survey (November 2020-July 2021) derived from validated questionnaires (Australian Breastfeeding Knowledge and Attitudes Questionnaire and the Workplace Breastfeeding Support Scale) with minor local adaptations. Interviews highlighted the beneficial effects of supportive workplace policies, the importance of physical spaces to facilitate proximity between mothers and infants, and the problem of low milk production. Meeting the WHO recommended practices of exclusive breastfeeding to 6 months or total breastfeeding to 2 years or more was more common in sites with higher levels of breastfeeding support (aOR 7.3, 95%CI 1.8, 29.1 for exclusive breastfeeding). Exclusive breastfeeding was also higher when staff set breastfeeding goals (aOR 4.4, 95%CI 1.7, 11.5). Staff who were able to see their infants during the work day were less likely to terminate breastfeeding because of work (aOR 0.3, 95%CI 0.1, 0.8). Staff who met both WHO recommendations themselves were more likely to report high levels of confidence caring for breastfeeding patients (aOR 2.6, 95%CI 1.1, 6.4). Workplace protections including supportive maternity leave policies and child-friendly spaces can improve breastfeeding outcomes for healthcare workers. These improved outcomes are then passed on to patients who benefit from healthcare workers who are more confident and attentive to breastfeeding problems.

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卫生保健工作者母乳喂养经验和做法的决定因素及其与母乳喂养母亲护理的关系：泰国北部的一项混合方法研究

提高母乳喂养率是预防婴儿死亡最具成本效益的方法之一，但世界大部分地区的母乳喂养率远远低于世卫组织建议的母乳喂养做法。自信、消息灵通的医护人员是促进母乳喂养的重要资源，但医护人员本身也面临着提前停止母乳喂养的风险。文化、种族和社会经济地位影响母乳喂养率，据报告，泰国是东南亚母乳喂养率最高和最低的国家。本研究探讨了母乳喂养的工作场所决定因素、医护人员的个人母乳喂养结果以及医护人员为患者提供的母乳喂养护理之间的关系。本研究采用了序贯探索性设计，以基于社会生态/生态心理学模型的概念框架为指导。参与者来自泰国北部的四个临床地点，来自母乳喂养率高的缅族或克伦族社区，以及母乳喂养率低的泰国社区。在深入访谈（2020年7月至2020年11月）之后，根据经过验证的调查问卷（澳大利亚母乳喂养知识和态度调查问卷以及工作场所母乳喂养支持量表）进行了定量调查（2020年11月至2021年7月），并在当地进行了细微调整。采访强调了支持性工作场所政策的有益影响、物理空间对于促进母亲和婴儿之间的亲密关系的重要性以及产奶量低的问题。在母乳喂养支持水平较高的地区，符合世界卫生组织建议的纯母乳喂养至 6 个月或完全母乳喂养至 2 岁或更长的做法更为常见（纯母乳喂养的 aOR 7.3，95% CI 1.8，29.1）。当工作人员设定母乳喂养目标时，纯母乳喂养率也更高（aOR 4.4，95%CI 1.7，11.5）。能够在工作日看到婴儿的员工因工作而终止母乳喂养的可能性较小（aOR 0.3，95%CI 0.1，0.8）。符合世界卫生组织建议的工作人员更有可能对照顾母乳喂养患者充满信心（aOR 2.6，95%CI 1.1，6.4）。工作场所保护，包括支持性产假政策和儿童友好空间，可以改善医护人员的母乳喂养结果。然后，这些改善的结果会传递给患者，他们受益于对母乳喂养问题更加自信和关注的医护人员。