title: Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: a quantitative analysis.
abstract: OBJECTIVE
  guidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50-60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands.
  
  
  METHODS
  national online survey.
  
  
  METHODS
  the Netherlands.
  
  
  METHODS
  gynaecologists and midwives.
  
  
  METHODS
  in the online survey, we identified the determinants that positively or negatively influenced the professionals׳ adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline.
  
  
  RESULTS
  364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that 'every client should undergo ECV'. Self-efficacy (perceived skills) was the most important determinant influencing adherence.
  
  
  CONCLUSIONS
  self-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV.
  
  
  CONCLUSIONS
  to improve adherence to the guidelines on ECV we must improve self-efficacy.
authors: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: a.n.rosman@amc.uva.nl.
authors: Ageeth N
authors: AN
authors: Rosman
authors: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Floortje
authors: F
authors: Vlemmix
authors: The Royal Dutch Organisation for Midwives, Utrecht, The Netherlands.
authors: Antje
authors: A
authors: Beuckens
authors: TNO Department of Child Health, Leiden, The Netherlands.
authors: Marlies E
authors: ME
authors: Rijnders
authors: Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Brent C
authors: BC
authors: Opmeer
authors: The Robinson Institute | School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA Australia.
authors: Ben Willem J
authors: BW
authors: Mol
authors: Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marjolein
authors: M
authors: Kok
authors: TNO Department of Life Style, Leiden, The Netherlands.
authors: Margot A H
authors: MA
authors: Fleuren
mesh_terms: D001946:Breech Presentation / Q000451:nursing*; D003144:Communication Barriers; D005260:Female; D006801:Humans; D008880:Midwifery; D009426:Netherlands; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014710:Version, Fetal / Q000451:nursing*
keywords: Determinants; External cephalic version; Guidelines; Implementation