A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

BackgroundImplementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging.AimTo identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation.MethodSeven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis.FindingsThree overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.ConclusionsHealth care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.     

Romantic Relationships at Work: Why Love Can Hurt

The academic community, practitioner literature and newspapers have all taken an interest in workplace romance. This paper aims to review the literature on workplace romance and to argue that the issue of power is key to understanding the negative consequences for individuals and organizations, linking workplace romance with theories or explanatory models of power. The paper first examines definitions of workplace romance, presents evidence of its prevalence, distinguishes between different types of workplace romance, and then looks at the main issues that managers and organizations face when considering the issue. The approaches taken by research in management, law, psychology and sociology are contrasted. The motivations for romance and the place of culture are described. Secrecy, gender differences and the negative and positive outcomes for men and women are discussed. The link between romance and harassment is explored. The paper looks at what organizations have done to manage romance. The research methods that have been used are reviewed, as are the gaps and weaknesses in order to make recommendations for future research. The review synthesizes accumulated knowledge in both research and practice, ending by identifying recommendations for managers.     

Coming out of the Therapy Closet: Women’s Disclosure of Same-sex Attraction in Counselling

“Coming out” is a process that same-sex attracted people undergo if they choose to acknowledge it to others. Minimal research exists examining the coming-out experience for same-sex attracted women in counselling settings. This qualitative study addressed the gaps in existing research by exploring counsellors’ perceptions of factors influencing same-sex attracted female clients to disclose their sexual orientation to a counsellor. Semi-structured interviews were conducted with 10 counsellors from diverse clinical backgrounds. In their view, the main factors influencing disclosure were the perceived lesbian, gay, bisexual, and queer (LGBQ) friendliness of a service or counsellor; the presence of LGBQ symbols within services; using gender-neutral language; and the level of a client’s self-acceptance of their sexual orientation. These findings suggest that the utilisation of culturally affirming models by counsellors working with same-sex attracted female clients can create a safe environment for disclosure of sexual orientation.     

Collaborating with families in differential responses: practitioners' views

Child protection authorities in many countries are concerned with reducing the rates of investigations and with diverting at‐risk families from the child protection service system. In several countries, differential responses have been introduced into child protection law providing service providers with some choice between investigative or family support pathways, depending upon the level of risk posed in the circumstance. In this paper, we report on a study into a form of differential response known as Intervention with Parents' Agreement introduced in Queensland, Australia, in 2005. A unique feature of this differential response is that it occurs after an initial child protection investigation, although it does provide child protection services with options for providing supportive interventions to at‐risk families to prevent the further escalation of concerns. In this paper, we analyse practitioners' perceptions of factors that inhibit and promote implementation of the Intervention with Parents' Agreement. Drawing upon interviews with 25 practitioners, we identify factors that become important for securing participation after an initial investigation has occurred. We discuss the implications for the development of differential responses in child protection service systems.     

The social services response to unaccompanied children in England

In England, social services departments have a duty to provide care and protection to unaccompanied asylum seeking children from the point they arrive in the country. In recent years, research studies have identified a number of practice and policy issues of concern regarding the social services response to unaccompanied children. This paper focuses on three broad issues that emerge from the literature. The paper explores research concerns associated with (i) the referral and assessment process, (ii) the use of the child welfare legislative framework, and (iii) a number of issues arising from the provision of placements and other support offered to unaccompanied children. The findings of the research reviewed demonstrate that there are indeed clear grounds for concern. However, this paper argues that the evidence base is relatively weak and that as a result we know very little about the nature and context of the social work response to this group of children and young people.     

Re‐invigorating democracy?: White middle class identities and comprehensive schooling

Recent research on social class and whiteness points to disquieting and exclusive aspects of white middle class identities. This paper focuses on whether ‘alternative’ middle class identities might work against, and disrupt, normative views of what it means to be ‘middle class’ at the beginning of the 21^st Century. Drawing on data from those middle classes who choose to send their children to urban comprehensives, we examine processes of ‘thinking and acting otherwise’ in order to uncover some of the commitments and investments that might make for a renewed and reinvigorated democratic citizenry. The difficulties of turning these commitments and investments into more equitable ways of interacting with class and ethnic others which emerge as real challenges for this left leaning, pro‐welfare segment of the middle classes. Within a contemporary era of neo‐liberalism that valorises competition, individualism and the market even these white middle classes who express a strong commitment to community and social mixing struggle to convert inclinations into actions.     

Pre‐teenage Children's Experiences with Alcohol

This article reports on the drinking experiences and motivations of 77 pre‐teenage children. The main reason which the children gave for occasional or regular drinking was the pleasure which they derived both from the effects of the alcohol and from the social interaction which accompanied the activity. Several of the children claimed that they were partly motivated by boredom. Peer influence appeared to play a minor role as far as the recurrent consumption of alcohol was concerned. A number of causes for concern are identified in the article. These include the frequency of the children's drinking and the volume of alcohol consumed by some of them; their tendency to combine different types of alcoholic drink in the same session; the unreliability of measures undertaken by the children to reduce risk and ensure their safety and the ease with which alcohol could be obtained. These findings emphasise the need for drug education programmes to alert children to the dangers of alcohol consumption and equip them with the skills to deal effectively with peer pressure. There is also a pressing need to improve the leisure facilities available for young people as alternatives to drinking and other problem behaviour. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau.     

A controlled donor imputation system for a one-number census

Summary. The 2001 UK census was a one-number census. An integral part of such a process has been the creation of a transparent census database that has been adjusted for the underenumeration in the 2001 census. The methodology for creating this database is based on a controlled donor imputation system that imputes individuals and households estimated to have been missed in the census. This paper describes this methodology and provides results from a statistical assessment of its performance using data that realistically simulate the census process.     

‘Can I come home?’ The experiences of young runaways contacting the Message Home helpline

This paper reports the findings of a 3‐month survey of young people calling the Message Home helpline. Message Home is a national freephone helpline available to people who have run away or left home which allows them to send a message to their family or carer, to seek confidential help and advice and, if necessary, to be helped to a place of safety. The paper explores the characteristics, circumstances and motivations of the young people contacting the helpline. It also considers who the young people contacted through the helpline and the kinds of messages that were relayed to parents, social services and others. This study differs from most preceding studies of runaways in recording the views of young people while they are missing. The immediacy palpable in their accounts highlights the distress and isolation experienced by many of these young people who have run away or been forced to leave home.