Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines

Abstract

BackgroundThe ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand) antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework.MethodsSemi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored.ResultsSeventy-three health professionals completed either a semi-structured interview (n = 35) or on-line questionnaire (n = 38). Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities.ConclusionThis study has identified some of the enablers and barriers to implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines using the validated Theoretical Domains Framework, as perceived by health professionals. We have identified differences between individual health professional groups and organisations. The identification of these behavioural determinants can be used to enhance an implementation strategy, assist in the design of interventions to achieve improved implementation and facilitate process evaluations to understand why or how change interventions are effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1858-8) contains supplementary material, which is available to authorized users.

Evaluatıon of the timing and indications of antenatal corticosteroid administration

“…Patients giving birth before the optimal period benefit less from steroid administration (9). Conversely, in those giving birth after the optimal period both fetus and mother are exposed to the toxic effects of the drug without benefit (18,19). In cases of acute conditions, which may be life threatening for mother or fetus, emergency of labor results in time restrictions, while the insufficiency of tests to accurately predict the timing of birth as in spontaneous preterm labor may lead to prolongation of this interval.…”

SUMAMOS EXCELENCIA® Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS)

“…This lack of consensus increases the risk of making mistakes, the inappropriate use of resources, and the continuation of practices that are ineffective or even potentially harmful [1,3]. However, the use of research is a complex process, in which the characteristics of the healthcare professionals, the organizations (context) and the innovation itself are related [3][4][5].…”

The SUMAMOS EXCELENCIA Project

“…The lack of consensus in how to apply recommendations can increase the risk of making mistakes and the misuse of the material and human resources that are available (Forbes & Griffiths, ; Milner, Estabrooks, & Myrick, ; Sackett, Rosenberg, Gray, Haynes, & Richardson, ; Shaneyfelt, Mayo‐Smith, & Rothwangl, ). Some authors report that 30% to 40% of patients do not receive research‐based care and that 20% of the care that is provided might be unnecessary or potentially harmful (Grol & Grimshaw, ; Mc Goldrick, Crawford, Brown, Groom, & Crowther, ; Schuster, McGlynn, & Brook, ).…”

“…Research is a complex process, influenced by the factors, characteristics, and attributes of individuals, organizations and innovation per se (Estabrooks, ; Mc Goldrick et al., ; Meijers et al., ; Squires et al., ). It also includes political, organizational, socio‐economic, and attitudinal components (Kitson, Ahmed, Harvey, Seers, & Thompson, ; Meijers et al., ; Squires et al., ).…”

“…A comprehensive evaluation of barriers and facilitators is the key to developing an implementation strategy and achieving subsequent improvements in practice (Mc Goldrick et al, ). This process will show the causal mechanisms that enable the intervention to work and how the chosen intervention modified, or improved, the previously identified, barriers and facilitators (Grimshaw et al., ).…”