Oude Wesselink Sandra F, Stoopendaal Annemiek, Erasmus Vicki, Smits Déan, Mackenbach Johan P, Lingsma Hester F, Robben Paul B M
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
BMC Health Serv Res. 2017 Apr 13;17(1):270. doi: 10.1186/s12913-017-2198-z.
The Dutch Healthcare Inspectorate supervises care providers in order to improve quality of care. Recently the inspectorate assessed and promoted the use of a guideline on smoking-cessation counselling in midwifery practices. The supervision programme consisted of an announcement of the enforcement deadline for the guideline and site visits. The purpose of our qualitative study was to identify factors related to guideline adherence after the supervision programme, and investigate whether the programme had helped improve adherence.
We conducted semi-structured interviews with inspected and non-inspected midwives. Additionally, we studied documents and observed the inspection process. The sampled midwives all work in primary care midwifery practices providing care to pregnant smokers. The questions included the current provision of smoking-cessation counselling, support to the midwife in counselling, recent changes in provision of counselling, reasons for recent changes, knowledge about the supervision programme, and experiences with supervision by the inspectorate.
Our results show that guideline adherence depends on several factors. Awareness and familiarity with the guideline are important, as is outcome expectancy. Additionally, motivation, guideline factors and environment factors were mentioned. Besides these previously documented factors, we found that professional collaboration also determined guideline adherence. Increased collaboration in counselling is associated with greater adherence to the guideline, such as provision of counselling and taking required training. The supervision programme helped improve stop-smoking counselling, by making midwives aware of the counselling and giving them an extrinsic motivation to provide counselling.
Motivation and environmental aspects were the most important factors related to guideline adherence, and professional environment was added as significant factor. The improved guideline adherence is partly attributable to the supervision programme.
荷兰医疗保健检查局对护理提供者进行监督，以提高护理质量。最近，该检查局评估并推广了一项助产实践中戒烟咨询指南的使用。监督计划包括宣布该指南的执行期限和进行实地考察。我们定性研究的目的是确定监督计划后与指南依从性相关的因素，并调查该计划是否有助于提高依从性。
我们对接受检查和未接受检查的助产士进行了半结构化访谈。此外，我们研究了文件并观察了检查过程。抽样的助产士均在为吸烟的孕妇提供护理的初级护理助产实践中工作。问题包括当前戒烟咨询的提供情况、助产士在咨询中的支持、咨询提供的近期变化、近期变化的原因、对监督计划的了解以及对检查局监督的体验。
我们的结果表明，指南依从性取决于几个因素。对指南的认识和熟悉程度很重要，结果预期也是如此。此外，还提到了动机、指南因素和环境因素。除了这些先前记录的因素外，我们发现专业协作也决定了指南依从性。咨询中协作的增加与对指南的更高依从性相关，例如提供咨询和参加所需培训。监督计划通过让助产士了解咨询并给予他们提供咨询的外在动机，帮助改善了戒烟咨询。
动机和环境方面是与指南依从性相关的最重要因素，专业环境也被视为重要因素。指南依从性的提高部分归因于监督计划。
