Identifying the barriers to universal cervical length screening for preterm birth prevention at a tertiary hospital in Thailand (physician perspectives): implementation research

Abstract

Background: To identify physicians’ perspectives of the barriers to cervical length screening to prevent preterm births.Methods: A prospective, descriptive, implementation study was carried out at the official rooms, tertiary hospitals. Ethics approval was obtained from the Siriraj Ethics Committee of the Faculty of Medicine Siriraj Hospital, and the work was registered at the Thai Clinical Trials Registry (TCTR20190813003). Physicians at 52 tertiary hospitals throughout Thailand were recruited. In Phase I of this prospective descriptive implementation study, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was administered to 120 Phase-III participants. Results: Virtually all respondents (118/120 [98.3%]) were obstetricians or gynecologists, with 25/120 (20.8%) specializing in maternal and fetal medicine. The large majority (108 [90.0%]) reported that their tertiary hospitals have action plans to prevent preterm births. Most physicians (99 [82.5%]) participated in the formulation of policies for preterm-birth prevention. Most obstetricians (96 [80.0%]) also have heavy workloads. At most hospitals, the obstetricians (96 [80.0%]) can perform cervical length measurements via vaginal ultrasound without having the related certification. Moreover, at two-thirds of the tertiary hospitals, the obstetricians (73/120 [60.8%]) stated that screening is performed in the absence of clear guidelines for high-risk cases. Ways suggested to reduce the obstacles facing obstetricians are providing then with knowledge, skills, and training (68/120 [56.7%]) and reducing unnecessary workloads (51/120 [42.5%]).Conclusions: From the physicians’ perspectives, the barriers to performing cervical length measurements are heavy workloads and a lack of government funding for hormone-usage programs. High-risk pregnant women threatening preterm deliveries should be considered for screening.Trial registration: the work was registered at the Thai Clinical Trials Registry (TCTR20190813003), registered 14 August, 2019, http://www.thaiclinicaltrials.org/page_user/#.