Manon Lemonde

Aim: The aim of this pre-implementation study was to assess mothers’ experiences of barriers and facilitators of receiving breastfeeding education and obtaining personalised support to guide the implementation of an eHealth resource for use in perinatal clinical settings in a health region of Canada. Design: We conducted a pre-implementation descriptive, exploratory qualitative study. Setting: Canadian mothers were recruited online to complete a survey and indicate interest in being interviewed. Method: An online survey was completed by 78 Canadian mothers who had breastfed an infant; five of these mothers participated in online interviews. Inductive thematic analysis using Braun and Clarke’s six-step approach was conducted to identify concepts, ideas, and themes related to mothers’ breastfeeding education and support experiences. The six steps included (1) becoming familiar with the data, (2) generating initial codes, (3) generating initial themes, (4) reviewing themes, (5) defining and naming the themes, and (6) writing the thematic analysis. Results: Five main themes were developed from the analysis, capturing mothers’ experiences receiving breastfeeding information, including (1) negative emotions from breastfeeding education and support; (2) inconsistent and insufficient breastfeeding information from healthcare providers; (3) barriers to obtaining personalised, competent breastfeeding support; (4) making breastfeeding education more accessible, engaging, and inclusive; and (5) timing and delivery of breastfeeding education. Conclusion: Mothers continue to report challenges related to complex emotional processes, the availability of education and personalised support, and receiving conflicting information from healthcare providers. Standardising education in multiple modalities that includes information on where mothers can access personalised, competent breastfeeding support when needed are potential solutions to these barriers.

Background: Breastfeeding has many health benefits for babies and mothers, but many families face challenges in meeting breastfeeding recommendations. Grandparents often influence new parents’ infant feeding experiences, yet little is known about their knowledge, attitudes, experiences, and needs regarding supporting breastfeeding in Canada. Purpose: This non-experimental exploratory descriptive study aimed to explore the knowledge, attitudes, and experiences of grandparents and great-grandparents in supporting breastfeeding to inform intergenerational breastfeeding promotion programs. Methods: An online survey was completed by 111 grandparents and great-grandparents living in Canada. Results: Approximately, 96% of participants had one or more children that were breastfed and 53% had a child breastfeed for over 24 months. The mean knowledge score was 78, (S.D 5.5) and the mean attitude score was 69.7 (S.D 8.71). These scores were significantly positively correlated and higher among participants who had received breastfeeding education (p=0.01). Conclusion: Grandparents and great-grandparents want information tailored to their role in supporting breastfeeding. Providing them with accessible, trustworthy, and respectful education tailored to their experiences would assist with the provision of inclusive intergenerational family-centered care.

Background: Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes. Objective: This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation. Methods: This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings. Results: Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025. Conclusions: This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients. International Registered Report Identifier (IRRID): DERR1-10.2196/63099

BACKGROUND Telehomecare monitoring (TM) in patients with cancer is a complex intervention. Research shows variations in the benefits and challenges TM brings to equitable access to care, the therapeutic relationship, self-management, and practice transformation. Further investigation into these variations factors will improve implementation processes and produce effective outcomes. OBJECTIVE This study aims to concurrently analyze implementation and evaluate the effectiveness of TM for patients receiving anticancer oral therapy. The objectives are to (1) contextualize how and why TM is implemented according to (a) site characteristics, (b) team characteristics, and (c) characteristics of patients receiving anticancer oral therapy; (2) assess TM effectiveness for recording electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) according to the site, implementation process, and patient characteristics; (3) describe the acceptability and feasibility of TM from the perspectives of the people directly or indirectly involved and provide evidence-based actionable guidance in anticipation of provincewide implementation. METHODS This type II hybrid effectiveness-implementation study uses a concurrent mixed methods design. Evaluability assessment is integrated into an emerging practice in 3 participating sites to enable the evaluation of implementation strategies on TM clinical outcomes. Quantitative data for ePROMs and ePREMs will be collected using validated oncology questionnaire. Descriptive statistics and repeated measures using multiple linear mixed models and generalized estimating equations analyses will be undertaken alongside interpretive descriptive coding of qualitative data. Qualitative data will be gathered from key informants guided by the RE-AIM (reach, efficacy, adoption, implementation, maintenance) framework and its extension, PRISM (practical robust implementation and sustainability model). The concurrent approach allows results at multiple stages of this study to be integrated iteratively. The methodological choice aims to provide real-world data that are rigorous, rapidly usable in practice, and transferable to other settings. RESULTS Questionnaires were pretested and the technological platform was codeveloped with members of the cancer care team and patients. Preparatory work was carried out to configure the TM platform and activate coordinating mechanisms between members of the cancer care team, patients, information technology experts, and the research team. A steering committee with 3 working groups was established to oversee the technological, clinical, and evaluation aspects of this study. Recruitment of patients for ePROMs started in February 2024, and data collection is expected to continue until March 2025. Interviews with members of the cancer care team began in November 2024. Full analysis should be completed by September 2025. CONCLUSIONS This study will clarify how, why, for whom, and under what conditions TM can complement current care models. Our evaluability assessment will help to address implementation complexities and better understand intervention-to-practice operationalization so that implementation might be adapted to contextual factors without potentially harmful or inequitable impacts on patients. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/63099

Introduction: Women often experience breastfeeding difficulties leading to premature supplementation and cessation. Implementing evidence-informed eHealth resources in clinical interactions with health care providers (HCPs), both in the health department and hospitals throughout a health region may help address this longstanding clinical issue. However, the provision of an eHealth resource alone is not sufficient to increase breastfeeding rates and health literacy, as the effective implementation of the eHealth resource in clinical practice is required. As such, our study objective was to conduct a needs assessment with HCPs to determine the barriers, facilitators, and perceived acceptability of the eHealth resource. Methods: A non-experimental descriptive study was used to examine HCPs’ perceptions of barriers and facilitators to the implementation of an eHealth resource in clinical settings. HCPs completed an online questionnaire to determine barriers and facilitators informed by the Consolidated Framework for Implementation Research (CFIR). Results: HCPs (n=44) completed the survey and agreed the resource was credible (86%), up to date (84%), covered relevant topics (91%), would ease their ability to provide breastfeeding education (82%), and would increase consistent messaging (86%). They agreed it would increase parents’ breastfeeding health literacy (91%) and help parents meet their breastfeeding goals (86%). Concerns were expressed regarding how this would be used in clinical interactions due to challenges with navigation, searchability, and the large amount of content. Implications and Conclusion: HCPs rated the eHealth resource highly; however, adaptations to the local context are required. For effective implementation of interventions in clinical settings, HCPs’ perceptions should be explored to determine their specific needs and determine how to best adapt the intervention to their setting to increase acceptability and facilitate use in clinical interactions.

Breastfeeding is a public health priority, recommended by all leading health authorities. Although numerous interventions and global initiatives have demonstrated some effect on improving breastfeeding outcomes, breastfeeding rates remain suboptimal. Educational support is a component of these interventions that assists families to establish and maintain breastfeeding. Although parents are being provided with education, information that is received appears to be inconsistent resulting in breastfeeding recommendations not being met. The objectives of this paper are to discuss health literacy, the evidence in support of health literacy, and potential strategies to guide the implementation of breastfeeding interventions and program development.