Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK.
Faculty of Health & Wellbeing, School of Community Health and Midwifery, University of Central Lancashire, UCLAN, Brook Building, Victoria Street, Preston, PR17QT, UK.
BMC Pregnancy Childbirth. 2022 Feb 14;22(1):123. doi: 10.1186/s12884-022-04410-x.
Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users' and professionals' satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach.
A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies.
From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings.
The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
助产单位（MUs）与最佳围产期结局、提高服务使用者和专业人员的满意度以及最具成本效益的选择有关。然而，在许多国家，它们仍然不是产妇护理的主流选择。了解将这种护理模式融入产妇服务的有效策略，可以支持和为许多国家和地区仍需采取的 MU 实施过程提供信息。
使用 PRISMA 指南对有关新 MU 实施的定性和定量研究进行了系统的搜索和筛选（Prospéro 协议参考：CRD42019141443）。使用 CASP 清单评估纳入的文章。采用元综合分析方法进行分析。没有对时间或背景进行排除标准，以确保纳入不同的实施尝试，即使在不同的历史和社会环境下也是如此。进行敏感性分析以反映高质量研究的主要贡献。
经过筛选过程，从 1037 条初始引文中共确定了 12 项研究纳入本综述。综合分析突出了两个广泛的类别：实施准备和使用的策略。第一个类别包括与当地文化、组织和专业层面相关的方面，而第二个类别综合了纳入研究中在实施 MU 时确定的主要行动和要点。创建了一个逻辑模型来综合和直观地呈现研究结果。
所选研究来自一系列不同的环境和时间段，并使用了不同的策略。尽管如此，不同实施过程中还是发现了一致性。这些发现可用于系统地扩大 MU 的规模，并有助于解决系统、服务和个人层面的障碍。在实施这种护理模式时，需要解决这三个层面的问题。
