Background characteristics for the participating HCPs are to be found in Table 1. All HCPs, except four were female. Participating HCPs consisted of midwives, registered nurses, specialist registered nurses, assistant nurses, physicians and psychologists. The mean age of the HCPs was 45 and mean years in their profession was 14.
When beginning the training program, the HCPs reported their interest in breastfeeding as a median (range) of 8 (2–10) points on the 10-point scale. The HCPs rated their importance of their role in providing improved breastfeeding support in the care chain as a median (range) of 7 (3–10) points. The HCPs’ age correlated with how they rated their importance of their role in providing breastfeeding support (rs= 0,158, p = 0,016). The older age, the more important they rated their role. The Kruskal-Wallis test showed that there was a significant difference between the midwives’, registered nurses’, specialist registered nurses’, assistant nurses’, physicians’ and psychologists’ ratings regarding their interest in breastfeeding (p = 0.002) as well as the importance of their role in providing breastfeeding support (p < 0.001). Please see Table 2 for further information.
A positive correlation was seen between the HCPs interest in breastfeeding and whether they considered their role in improving breastfeeding support to be important (rs = 0,579, p < 0,001). After the training program, the HCPs estimated that their interest in breastfeeding had increased according to a median (range) of 9 (1–10) and considered that they had received new tools for breastfeeding support according to a median of 9 (3–10) points. The Kruskal-Wallis test showed a significant difference between the HCPs’ ratings regarding increased interest in breastfeeding (p = 0.031) and if they experienced they had received new tools for breastfeeding support (p = 0.005). Please see Table 2 for further information.
A positive correlation was seen between HCPs interest in breastfeeding before the training and whether they felt that their interest in breastfeeding had increased due to the training program (rs = 0.445, p < 0.001), and between their interest and whether they felt that they had been given new tools by the training to provide better breastfeeding support (rs = 0.363, p < 0.001).
Positive evaluation of the training program. Categories on what was particularly good about the training program by different participating professions are presented in Table 3.
Group discussions
The HCPs regarded the group discussions of the case scenarios as both important and fruitful. These sessions created a space for the HCPs to exchange attitudes, perspectives, and experiences, fostering mutual learning and insight. The opportunity for structured reflection was valuable, enabling a deeper engagement with the content. Additionally, the interactive format promoted active participation and collegial dialogue, contributing to a more meaningful and effective learning experience. One midwife wrote:” To watch the videos first and then go through everything again. Everything was very interesting. It gave me new inspiration to continue supporting breastfeeding women.”
The structure of the training program
The HCPs stated that the schematic structure of the training program was well designed and effective. It began with short films about breastfeeding, which participants had viewed in advance, allowing them to come prepared with a basic understanding of the subject. This was followed by a structured repetition of the film content during the training day, reinforcing core messages and facilitating knowledge retention. The program then progressed to group discussions of case scenarios, which encouraged sharing of diverse clinical experiences. Finally, the whole-class discussions provided an opportunity to synthesize insights from the smaller groups, clarify uncertainties and explore different approaches. A midwife stated: “It is good to repeatedly hear the same information.”
Inspiration to work with breastfeeding support
The HCPs stated that the training program served as a source of inspiration for their continued work with breastfeeding support. It reinforced the importance of their role in promoting and supporting breastfeeding in clinical practice. Additionally, the participants noted that the training helped them recall knowledge and evidence-based practices that had previously been set aside or faded from everyday use. This reactivation of existing knowledge was seen as both valuable and necessary, contributing to a renewed sense of confidence and competence in their professional responsibilities One midwife wrote: “This training raises the status of breastfeeding. How important breastfeeding is!” Another midwife shared: The training program gave me more motivation to work with breastfeeding support.”
New knowledge about breastfeeding
The HCPs stated that the training program day provided them with new knowledge about breastfeeding and breastfeeding support, enhancing their understanding of both practical and theoretical aspects. The participants emphasized that the content introduced updated information and evidence-based strategies that they had not previously encountered. The training day was described as a motivating experience that not only deepened their expertise but also strengthened their commitment to promoting breastfeeding and supporting mothers more effectively in their clinical work. One assistant nurse wrote: “I have gained new thoughts on what and how I can talk about breastfeeding with parents”.
Useful material
Further, the HCPs highly valued the information material provided. They described it as clear, relevant, well-structured and offering practical guidance. The material was seen as a useful resource for reinforcing key messages about breastfeeding. The participants also expressed that the material would be beneficial to use as tools in their ongoing work with breastfeeding support. One assistant nurse wrote: It was good to see the films and later get a repetition of its content. Everything was very interesting!” and a midwife shared: “The flipchart is a fantastic tool”.
Mixed professions
The HCPs stated that it was particularly valuable that individuals from different professional backgrounds participated in the training program. They emphasized that having a mix of roles—such as midwives, nurses, physicians, and other HCPs enriched the discussions and allowed for a broader exchange of perspectives. This interdisciplinary approach was seen as essential for fostering a shared understanding and promoting cohesive, team-based care. The participants expressed a clear need for a dedicated arena where they could come together across professional boundaries, strengthen interprofessional collaboration, and align their approaches to breastfeeding support. The training program was therefore not only an educational opportunity, but also a much-appreciated forum for team-building and mutual learning One physician wrote: “It was particularly good to gather with representatives from all parts of the care chain”. One assistant nurse wrote: “It was good to meet different professions and share experiences. It provides better collaboration between different professions.” One specialist nurse wrote: It was good to meet staff from other units and discuss how we work.”
Suggestions on how to improve the training program
For information about categories on how to improve the training program by different participating professions, please see Table 4. The HCPs had less improvement suggestions to share than comments on what was particularly good about the training program. However, some HCPs gave comments on this question and their answers resulted in five categories.
Fewer cases, more time for discussions
The HCPs stated that there were too many case scenarios and that they would have wanted more practical tips on breastfeeding support. One midwife wrote: “Shorten the cases. Three is enough, four is too many. It was a long day when you’re not used to sitting still and listen”.
Lack of participants of different professions
The HCPs stated that it was valuable to meet up with other professions and they were dissatisfied with the fact that some professions, or units, were few or did not participate at all. One midwife wrote: “It would have been better if the midwives from the health care centers also joined” and another midwife stated that “there were too few physicians who participated”.
Practical exercises and tips
The HCPs stated that they would have wanted more practical information on breastfeeding support and tips on what to do when breastfeeding problems occurs. One midwife wrote: “I would have wanted to know more about hand milking and other practical tips”. Another midwife wrote: “What to do when the woman is in pain…what to do when the baby does not latch at all and when the situation becomes increasingly chaotic.”
New information
Also, the HCPs wished for further information that had not been presented or discussed during the day and expressed a need for more evidence-based facts about breastfeeding. One psychologist wrote: “I would have wanted more clear links to relevant and up-to-date research.”
Breaks during the day
The HCPs stated that they would have wanted more breaks throughout the day. One physician put it as follows: “A little more leg stretching and a cookie for the afternoon coffee.”
Suggestions for improvement regarding breastfeeding support at work
During the interprofessional group discussions, the groups submitted their suggestions for improvement regarding breastfeeding support at their unit and/or in the care chain. In the analysis of these suggestions, three categories were identified: Material things that can be improved, Changes in the way HCPs work and Employee welfare.
Material things that can be improved
The HCPs stated that breastfeeding information and information about skin-to-skin for parents in different formats were important. They suggested updated information, both online and as brochures, and that recurring information would be broadcasted on a television in both common areas and in the patient rooms. They also wished that the information should be available in several languages, apart from Swedish. Another improvement suggested by the HCPs was to remove sleeping pods for the babies and instead offer baby slings to the families to increase skin-to-skin care and to make it easier for parents to learn their baby’s cues. They also mentioned the physical environment and suggested improvements for a more home-like feeling such as the need for specific nursing chairs, possibility of dimmed illumination and larger beds to enable secure bed sharing. To improve the care within the care chain, the HCPs suggested standardized training material and information as well as check lists of information that must be given to parents before discharge.
Changes in the way the HCPs work
The HCPs were coherent about that breastfeeding and the nine innate steps of the infant should be prioritized above other chores. For example, they suggested prioritizing the first breastfeeding session after birth and that oftentimes tasks such as repairing vaginal tears can be postponed. They also stressed the possibility to improve the strive for zero-separation when either mother or baby are in need for more advanced healthcare, i.e. at the intensive care unit or the NICU. The HCPs also stressed the importance of adequate pain relief for both mothers and infants after cesarean section or vacuum extraction.
Employee welfare
For the HCPs, it was important that inter-professional training program dedicated for breastfeeding should be recurrent and that new staff should undergo the same training. Other things to be improved according to the HCPs was more staff or less patients/HCP at each unit/health clinic, which would leave more time for breastfeeding support. They also wished for clear memos on various care situations such as zero-separation and the phasing out of infant formula. The HCPs also stated that the collaboration between units as well as outpatient clinics should be improved, specifically between prenatal care and child health centers and that it was important to involve the partner during breastfeeding education or support.
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