Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals

Kaplan, Heather C.; Sherman, Susan N.; Cleveland, Charlena; Goldenhar, Linda M.; Lannon, Carole; Bailit, Jennifer L.

doi:10.1136/bmjqs-2015-003984

Cited by 20 publications

(40 citation statements)

References 25 publications

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“…Due to the nature of the care provided, which is both preventative and curative, the strong medico-legal concerns associated with obstetrics and often the short decision time encountered in emergency situations, many participants in our study expressed the need for the guidelines to be easily accessible and accompanied by multifaceted intervention tools. Through the process of this study we were able to examine some of the principles of reliability science [34] by asking health professionals to identify implementation tools that would facilitate uptake of the guideline recommendations and subsequently improve practice. Participants expressed the need for implementation tools that facilitate prescription and administration of antenatal corticosteroids and enable monitoring of practice over time to ensure compliance with the guideline recommendations.…”

Section: Discussionmentioning

confidence: 99%

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

Goldrick

Crawford

Brown

et al. 2016

BMC Health Serv Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Goldrick

Crawford

Brown

et al. 2016

BMC Health Serv Res

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“…In summary, the 46 included studies were conducted in 32 countries in Region of the Americas (6 countries: United States of America [ 24 , 40 – 51 ], Canada [ 44 , 52 – 54 ], Mexico [ 55 , 56 ], Ecuador [ 56 ], El Salvador [ 56 ], and Uruguay [ 56 ]), Western Pacific Region (7 countries: Australia [ 23 , 57 – 63 ],New Zealand [ 58 – 64 ], Vietnam [ 22 ], Singapore [ 65 ], Taiwan [ 66 , 67 ], Cambodia [ 68 ], and Philippines [ 68 ]), European Region (4 countries: United Kingdom [ 69 – 72 ], Ireland [ 73 ], Sweden [ 74 ], and France [ 75 , 76 ]), Southeast Asia Region (4 countries: Thailand [ 77 ], Bangladesh [ 22 ], India [ 22 , 78 ], and Nepal [ 22 ]), Eastern Mediterranean Region (2 countries: Afghanistan [ 22 ] and Pakistan [ 22 ]), Africa region (9 countries: Cameroon [ 22 ], Democratic Republic of Congo [ 22 , 79 ], Kenya [ 22 ], Malawi [ 22 , 79 – 81 ], Nigeria [ 22 , 79 ], Uganda [ 22 , 79 ], Ethiopia [ 79 ], Sierra Leone [ 79 ], and Tanzania [ 79...…”

Section: Resultsmentioning

confidence: 99%

“…Five studies included perspectives of women and/or their partners [ 51 , 52 , 62 , 63 , 67 ], 3 studies included both women’s and provider’s perspectives [ 78 , 80 , 81 ], and the remaining 38 studies included only health providers’ perspectives [ 22 – 24 , 40 – 50 , 53 – 61 , 64 – 66 , 68 – 77 , 79 , 82 ].…”

Section: Resultsmentioning

confidence: 99%

Factors influencing appropriate use of interventions for management of women experiencing preterm birth: A mixed-methods systematic review and narrative synthesis

et al. 2022

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Background Preterm birth-related complications are the leading cause of death in newborns and children under 5. Health outcomes of preterm newborns can be improved with appropriate use of antenatal corticosteroids (ACSs) to promote fetal lung maturity, tocolytics to delay birth, magnesium sulphate for fetal neuroprotection, and antibiotics for preterm prelabour rupture of membranes. However, there are wide disparities in the rate and consistency in the use of these interventions across settings, which may underlie the differential health outcomes among preterm newborns. We aimed to assess factors (barriers and facilitators) affecting the appropriate use of ACS, tocolytics, magnesium sulphate, and antibiotics to improve preterm birth management. Methods and findings We conducted a mixed-methods systematic review including primary qualitative, quantitative, and mixed-methods studies. We searched MEDLINE, EMBASE, CINAHL, Global Health, and grey literature from inception to 16 May 2022. Eligible studies explored perspectives of women, partners, or community members who experienced preterm birth or were at risk of preterm birth and/or received any of the 4 interventions, health workers providing maternity and newborn care, and other stakeholders involved in maternal care (e.g., facility managers, policymakers). We used an iterative narrative synthesis approach to analysis, assessed methodological limitations using the Mixed Methods Appraisal Tool, and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. Behaviour change models (Theoretical Domains Framework; Capability, Opportunity, and Motivation (COM-B)) were used to map barriers and facilitators affecting appropriate use of these interventions. We included 46 studies from 32 countries, describing factors affecting use of ACS (32/46 studies), tocolytics (13/46 studies), magnesium sulphate (9/46 studies), and antibiotics (5/46 studies). We identified a range of barriers influencing appropriate use of the 4 interventions globally, which include the following: inaccurate gestational age assessment, inconsistent guidelines, varied knowledge, perceived risks and benefits, perceived uncertainties and constraints in administration, confusion around prescribing and administering authority, and inadequate stock, human resources, and labour and newborn care. Women reported hesitancy in accepting interventions, as they typically learned about them during emergencies. Most included studies were from high-income countries (37/46 studies), which may affect the transferability of these findings to low- or middle-income settings. Conclusions In this study, we identified critical factors affecting implementation of 4 interventions to improve preterm birth management globally. Policymakers and implementers can consider these barriers and facilitators when formulating policies and planning implementation or scale-up of these interventions. Study findings can inform clinical preterm birth guidelines and implementation to ensure that barriers are addressed, and enablers are reinforced to ensure these interventions are widely available and appropriately used globally.

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“…Many perinatal collaboratives use treatment with ANCS as a marker of quality, and rates of ANCS have increased to about 90% for deliveries 24 to 34 weeks. 35,36 However, of concern, there has been a subsequent increase in suboptimal treatment (less than 24 hours or more than 7 days before delivery) and questionably appropriate treatment (35 weeks or greater exposed to ANCS). In all live births in Nova Scotia from 1998-2012, the rates of suboptimal treatment were 34% (odds ratio 6.7, 95% CI 3.9-11.6) and questionably appropriate treatment of 1.7% (odds ratio 7.5, 95% CI 4.9-11.3).…”

Section: A N U S C R I P Tmentioning

confidence: 97%

Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

Kamath‐Rayne

Rozance

Goldenberg

et al. 2016

American Journal of Obstetrics and Gynecology

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Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals

Cited by 20 publications

References 25 publications

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

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

Factors influencing appropriate use of interventions for management of women experiencing preterm birth: A mixed-methods systematic review and narrative synthesis

Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

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