Table 3.

Challenges related to BF education and barriers to curricular change

Categories	Challenges of the workforce (Health system)	Challenges around BF education (Education system)	Barriers to changes needed in curricula (Curricular change process)
Themes
Interprofessionalim	New HPs lack knowledge of roles and responsibilities of other professionals related to BF	Lack of consultation among the different programs training HPs regarding their BF content	None mentioned
Practical training	New HPs did not acquire sufficient skills for relevant BF support (e.g., assess initial latch and sucking behaviour, identify engorgement, cracking, thrush…)	Lack of opportunity for students to practice their clinical skills for BF support Lack of tools for teaching practical elements Lack of connection between training environments and practice settings	Lack of priority given to BF in the various programs Limited number of sites and short duration of practicum Lack of adequately trained teachers for BF Large number of students Financial issues Program rigidity Lack of time Small number of IBCLC certified lactation consultants
Course content	New HPs have acquired concepts that differ from one program to another and from one training institution to another	Freedom for content and lack of clarity in objectives to achieve appear to limit program development Several books and reference tools used are outdated as to BF data and recommendations BF courses are allocated without consideration for the professors/educators' expertise	Absence of specific standards or accreditation criteria for BF education Large number of programs to be harmonized Some rigidity within programs (e.g., difficult processes for changing course outline, delays) Limited number of hours available Fixed number of credits
Counselling	New HPs did not acquire sufficient BF knowledge to adequately counsel women and families	Lack of exposure to real life situations Key counselling situations for which HPs should be trained, have not been defined	Lack of available training hours to incorporate scenarios with real life situations Lack of expertise of teachers with BF counselling
Attitudes	HPs’ behaviours are strongly influenced by several intrinsic and extrinsic factors related to their own values, personal experiences, or social norms	Lack of understanding of the important influence of attitudes on professional practice Difficulty of changing attitudes which are often rooted in deep values (those of teachers, students, and professionals) Emotional charge related to BF	Limited amount of time and expertise to tackle this topic

Abbreviations: BF, breastfeeding; HPs, health professionals; IBCLC, International Board Certified Lactation Consultant