Analyse the barriers and challenges to

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Analyse the barriers and challenges to

The challenge lies in implementing these guidelines. The identification of specific barriers and facilitators represents a new approach for identifying the determinants of guidelines use by health professionals.

Data was obtained from two focus Analyse the barriers and challenges to sessions, with obstetricians from each of the three hospitals, dealing with induction of labour at term and fetal health surveillance in labour guidelines, and operative vaginal birth and vaginal birth after previous caesarean birth guidelines.

For secondary-level and tertiary-level hospitals, with more than 10 clinicians, focus groups were divided into two sessions; thus there were four focus groups in each hospital.


All obstetricians were approached to participate in the study. Data sources and collection A focus group gathers people from similar backgrounds or experiences to discuss a specific topic of interest.

Semi-structured interviews were conducted with clinicians who were not able to take part in the focus groups. The focus groups and personal interviews lasted approximately 90 minutes. A moderator, also referred to as an interviewer, conducted each focus group in the presence of an observer, but only the moderator conducted the semi-structured interviews.

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The moderator was in control of the session and was responsible for the direction taken by the focus group. The main tasks of the observer were to take notes, including non-verbal observations, to record and observe the session. All focus groups and interviews were audio-taped and transcribed verbatim.

The interviewer and observer reconstructed detailed notes of each interview immediately after the session.

Analyse the barriers and challenges to

An interview guide was used for all focus groups and interviews Annex 1, available at http: Focus groups and interviews about SOGC guidelines were structured in the following manner: Data analysis Analysis of transcripts was planned according to Graham Analysing the data from one hospital at a time, two researchers NC, ED jointly coded and categorized ideas into broader themes through consensus until all the transcripts were reviewed.

To ensure study rigor and reduce limitations, we used the logbook method in A manual for the use of focus groups to help analyse transcripts; 19 this consists of a table used to record answers on selected topics.

Focus groups and semi-directed interviews were separately analysed. Once all transcripts were analysed, results were reviewed to describe findings that apply to the study as a whole. As hypotheses were generated, we sought confirmation by returning to the transcripts to find evidence to refute or support these.

One obstetrician AD on the research team reviewed the analysis to ensure the accuracy of our interpretations and critical analysis during the entire process. Findings Ten focus groups divided into two sessions Annex 1 and six semi-structured interviews were conducted in the three hospitals.

Moreover, the guidelines are perceived as evidence-based and as a legal reference. Obstetricians also said the focus group sessions acted as strong facilitating factors, and that these should constitute the first step for improving the use of recommendations in practice.

Induction of labour at term 20 According to obstetricians, the augmentation of maternal request for induction at term was explained by maternal insecurity or logistic factors end of maternity leave because of insufficient information about the delay between estimated and real birth dates.

Consequently, providing the latest expected birth date to women instead of the mean expected birth date has been perceived as a potential facilitator to reduce induction on maternal request.

Moreover, obstetricians said that when they were planning an induction, explanations about the method to be used, side-effects, risks of caesarean section and possible complications were insufficiently discussed with the woman.

Medico-legal concerns also encouraged induction for convenience and the rise of induction of labour before 41 complete gestation weeks. Indeed, a general proactive approach was seen by obstetricians as a means to reduce potential risk of lawsuits. The unavailability of induction during the weekend has also been perceived as an important barrier to change, increasing the risk of induction failure because women may be induced two days before the expected date.

This may lead to an interruption of labour, then to a caesarean section. The adoption of a departmental policy in hospital B promoting the standardization of induction at term positively influenced the use of recommendations.

Staff meetings, formal protocols for induction at term and standardized information to women contributed to enhance the adoption of the recommendations and to reduce induction at maternal request.

Fetal health surveillance in labour Obstetricians noted a slow uptake of intermittent auscultation in the delivery unit. There is some evidence that the use of continuous electronic fetal monitoring may lead to increased false positives for fetal hypoxemia and to resulting caesarean sections.

However, it could have negative effects on the progress of labour because of the lack of psychological support to the mother. Obstetricians also noted that unavailability of equipment was an important barrier to accurately diagnosing fetal hypoxemia.

The absence of a pH meter at hospital B was identified as a practical impediment to an optimal use of recommendations because obstetricians cannot use fetal scalp blood sampling to investigate non-reassuring patterns of the electronic fetal monitoring.

Moreover, when a pH meter was available, the use of fetal scalp blood sampling might be limited because of technical limitations, including the skill level of operators, anatomical difficulties associated with the procedure and associated pain experienced by the woman.

Fear of lawsuits was also suggested as a factor that limits the use of intermittent auscultation. Obstetricians described continuous electronic fetal monitoring as reassuring because this method is based on objective criteria, and an electronic fetal monitoring paper strip represents a strong evidence of good practice in case of lawsuits.

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Obstetricians also noted that continuous electronic fetal monitoring helps to supervise students and residents in the delivery unit. However, some obstetricians thought that medico-legal concerns may also encourage the use of intermittent auscultation because interpretation of the strip is difficult and variable.Analyse the Barriers and Challenges to Communication Within Own Job Role; Analyse the Barriers and Challenges to Communication Within Own Job Role.

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