title: Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study.
abstract: BACKGROUND
  Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada.
  
  
  METHODS
  Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2.
  
  
  RESULTS
  Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.
  
  
  CONCLUSIONS
  Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.
authors.affiliation: School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada. sonia.semenic@mcgill.ca.
authors.forename: Sonia
authors.initials: S
authors.lastname: Semenic
authors.affiliation: University of Ottawa, 1 Stewart Street, Ottawa, Ontario, K1N 6 N5, Canada. nedwards@uottawa.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: Edwards
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1 N4, Canada. premjis@ucalgary.ca.|Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Dr. NW, Calgary, AB, Canada. premjis@ucalgary.ca.
authors.forename: Shahirose
authors.initials: S
authors.lastname: Premji
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada. joanne.olson@ualberta.ca.
authors.forename: Joanne
authors.initials: J
authors.lastname: Olson
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada. beverly.williams@ualberta.ca.
authors.forename: Beverly
authors.initials: B
authors.lastname: Williams
authors.affiliation: School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada. pmontgomery@laurentian.ca.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D026683:Advisory Committees; D002170:Canada; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008499:Medical Records / Q000592:standards*; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research