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health. Because this belief may affect breastfeeding policies and practices in the child care environment, this may be an area which would merit further intervention. Research on factors related to breastfeeding discontinuation indicates that women who encounter multiple barriers to breastfeeding are more likely to cease breastfeeding, while those who have a perceived support system are more likely to continue breastfeeding.xxxvi Therefore, it is important to foster supportive environments for breastfeeding women, particularly those who may just be returning to work as the return to work is often cited as a reason for why women stop breastfeeding.xxxvii
There were no site-based, language-based, or difference by coaching for these knowledge areas, indicating a need for and potential making a positive impact for all providers in this area in the future.
What challenges do participants face and does coaching make a difference? Does it differ by care type? Which challenges are more common at baseline compared with follow-up? Are there fewer challenges at follow-up?
Questions 38a-38k asked respondents “What are some challenges that you face or have faced while taking steps towards creating healthy practices or routines?” with a “check all that apply” instruction. Any participant who checked “Does not apply: I did not create healthy practices or routines” or “I did not face any challenges to creating healthy practices or routines” did not have any other checked items included in the percentages reported in Table 10.
Challenges in creating healthy practices or routines reported at baseline and follow-up were very similar with no significant differences in the percent of participants reporting each item at baseline or follow-up. At both baseline and follow-up, 66.0% of participants identified at least one challenge in creating healthy practices or routines, and close to 30% reported no challenges. The areas of greatest challenge in creating healthy practices or routines at both baseline and follow-up included (starting with greatest challenge) with approximately 20% or more citing these challenges were:
 Lack of support from parents (34.7%)
 Not enough money to make changes (33.4%)
 Not enough equipment to make changes (20.4%)
 Not enough training to make changes (20.3%)
Improving Health in Child Care Settings: 2016 36

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