ORIGINAL RESEARCH Breastfeeding guidance in community pharmacies: The results of a mystery shopper study Judith MAHER 1 and Roger HUGHES 2 1 School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, and 2 Bond Institute of Health and Sport, Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia Abstract Aim: To assess the nature and quality of breastfeeding-related guidance provided by community-based pharmacy staff. Methods: A covert observational ‘mystery shopper’ study of 66 randomly selected community pharmacies was employed to assess actual breastfeeding guidance practices among pharmacy staff. A female mystery shopper used a scripted scenario designed to explore guidance practices relevant to breastfeeding promotion. Pharmacy staff: mystery shopper interactions were documented immediately following the exchange by the mystery shopper and a second shadow observer. These records were qualitatively analysed against a predetermined good practice frame- work of guidance expected for this scenario. Results: Of 66 pharmacies visited, the mystery shopper consulted with 18 pharmacists and 48 pharmacy assis- tants. Pharmacies visited included an equal mix of chain and independent pharmacies. The mean length of each mystery shopper to pharmacy staff interaction was 2.3 minutes (range of 0.5–10 minutes). In only 9 of 66 interactions was printed educational or product information provided to complement verbal advice. Most of this material (6/9) related to infant formula product information. Analysis of the content of guidance provided indicates limited advice being given regarding breastfeeding perseverance when confronted with breastfeeding difficulties (4/66), with most interactions involving direct advice regarding brands of infant formula to use. Conclusions: The quality of guidance provided by pharmacy staff in the context of breastfeeding promotion suggests a need for multistrategy intervention in the pharmacy setting and identifies a potential opportunity for collaborative interventions between nutrition, nursing and pharmacy practitioners to enhance infant-feeding guidance. Key words: breastfeeding, guidance, pharmacy. Introduction Breastfeeding promotion is universally recognised as a public health nutrition practice imperative with significant impact on health, social and economic outcomes. 1,2 Among a complex array of determinants that effect breastfeeding initiation and duration, inconsistent and/or ambivalent advice and support from health professionals is recognised as an unacceptable feature of health service delivery, that compounds socio-demographic and cultural barriers to breastfeeding. 3–5 Health service settings-based breastfeeding promotion initiatives that address the effect of service delivery practices and other environmental determinants of breastfeeding behaviours have been a focus for breastfeeding promotion effort worldwide. This is best demonstrated by the World Health Organisations Baby Friendly Hospital Initiative. 6 Among the literature investigating discipline-specific effects of attitude and guidance practices on maternal breast- feeding decisions, nursing and general practitioners have received most attention. 4,5,7 This is largely because of the relatively high level of exposure these professional groups have to new mothers in the health system. The role of community pharmacy as a setting for health promotion has recently been reviewed 8 ; however, community pharmacies and the professional staff that work in this health service setting have received limited attention in the literature in the context of breastfeeding promotion, and nutrition promo- tion more generally. This is surprising given that in devel- oped countries such as the UK and Australia community pharmacies are highly accessible (90% of the population J. Maher, MND, Lecturer R. Hughes, PhD, Professor of Nutrition & Dietetics Correspondence: R. Hughes, Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD 4217, Australia. Email: Rohughes@bond.edu.au Accepted March 2012 Nutrition & Dietetics 2013; 70: 153–157 DOI: 10.1111/j.1747-0080.2012.01641.x © 2013 The Authors Nutrition & Dietetics © 2013 Dietitians Association of Australia 153