Barrier identification and implementation strategy integration in the guidelines of optimal postpartum care for advanced maternal age in China: a study based on the CFIR-ERIC implementation strategy matching tool

Abstract

Background Due to advanced maternal age facing great risks of fertility, such as gestational hypertension, postpartum haemorrhage, miscarriage, etc., we must attach importance to postpartum care. Guidelines for optimal postpartum care are available. It is of great significance to identify potential barriers and tailor practical implementation strategies before implementing the guidelines. The purpose of this study aimed to use the implementation science methods to develop implementation strategies that could promote the implementation of postpartum care guidelines in clinical practice. Methods Purposive sampling was used to recruit 13 obstetric nurses who had previously participated in the implementation of the postnatal care guidelines for semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) of 39 structures guided us in collecting and analysing interview data to identify barriers. We then determined implementation strategies by using Consolidated Framework for Implementation Research–Expert Recommendations for Implementing Change (CFIR-ERIC) Implementation Strategy Matching Tool and taking into account the local context. Results The interview content was categorized, coded, and explained, and finally ten barriers were identified, including Evidence Strength & Quality, Complexity, Patient Needs & Resources, Compatibility, Structural Characteristics, Access to knowledge and information, Learning Climate, Knowledge & Beliefs about the Intervention, Self-efficacy, Key Stakeholders. Under the guidance of the CFIR-ERIC Implementation Strategy Matching Tool, some implementation strategies were developed to address these barriers for clinical nurses and the needs of patients and their families, which include conducting educational meetings, developing educational materials for nurses and patients, obtaining feedback from women and their families to meet their needs, rationalize implementation time, improve clinical assessment tools, streamline guideline-based workflows. Conclusion We can apply the CFIR-ERIC Implementation Strategy Matching Tool to select the best implementation strategies to address the barriers based on CFIR and promote the implementation of optimal postpartum care guidelines for advanced maternal age.