Barriers and enablers to implementing antenatal magnesium sulphate for fetal neuroprotection guidelines: a study using the theoretical domains framework.
BACKGROUND
Strong evidence supports administration of magnesium sulphate prior to birth at less than 30 weeks' gestation to prevent very preterm babies dying or developing cerebral palsy. This study was undertaken as part of The WISH (Working to Improve Survival and Health for babies born very preterm) Project, to assess health professionals' self-reported use of antenatal magnesium sulphate, and barriers and enablers to implementation of 2010 Australian and New Zealand clinical practice guidelines.


METHODS
Semi-structured, one-to-one interviews were conducted with obstetric and neonatal consultants and trainees, and midwives in 2011 (n = 24) and 2012-2013 (n = 21) at the Women's and Children's Hospital, South Australia. Transcribed interview data were coded using the Theoretical Domains Framework (describing 14 domains related to behaviour change) for analysis of barriers and enablers.


RESULTS
In 2012-13, health professionals more often reported 'routinely' or 'sometimes' administering or advising their colleagues to administer magnesium sulphate for fetal neuroprotection (86% in 2012-13 vs. 46% in 2011). 'Knowledge and skills', 'memory, attention and decision processes', 'environmental context and resources', 'beliefs about consequences' and 'social influences' were key domains identified in the barrier and enabler analysis. Perceived barriers were the complex administration processes, time pressures, and the unpredictability of preterm birth. Enablers included education for staff and women at risk of very preterm birth, reminders and 'prompts', simplified processes for administration, and influential colleagues.


CONCLUSIONS
This study has provided valuable data on barriers and enablers to implementing magnesium sulphate for fetal neuroprotection, with implications for designing and modifying future behaviour change strategies, to ensure optimal uptake of this neuroprotective therapy for very preterm infants.
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. emily.bain@adelaide.edu.au.
Emily
E
Bain
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. tanya.bubner@adelaide.edu.au.
Tanya
T
Bubner
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. pat.ashwood@adelaide.edu.au.
Pat
P
Ashwood
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. emer.vanryswyk@adelaide.edu.au.
Emer
E
Van Ryswyk
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. lucy.simmonds@alumni.adelaide.edu.au.
Lucy
L
Simmonds
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. sally.reid@adelaide.edu.au.|The Women's and Children's Hospital, North Adelaide, South Australia, Australia. sally.reid@adelaide.edu.au.
Sally
S
Reid
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. philippa.middleton@adelaide.edu.au.
Philippa
P
Middleton
Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. caroline.crowther@adelaide.edu.au.|Liggins Institute, The University of Auckland, Auckland, New Zealand. caroline.crowther@adelaide.edu.au.
Caroline A
CA
Crowther
D001291:Attitude of Health Personnel; D002547:Cerebral Palsy / Q000517:prevention & control*; D002983:Clinical Competence; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008880:Midwifery; D009359:Neonatology; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D009774:Obstetrics; D066087:Perinatal Death / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D047928:Premature Birth; D017010:Reminder Systems; D013021:South Australia; D013997:Time Factors
D018696:Neuroprotective Agents; D008278:Magnesium Sulfate