Dilworth Sophie, Doherty Emma, Mallise Carly, Licata Milly, Hollis Jenna, Wynne Olivia, Lane Cassandra, Wolfenden Luke, Wiggers John, Kingsland Melanie
Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.
Implement Sci Commun. 2024 Oct 9;5(1):112. doi: 10.1186/s43058-024-00655-z.
International clinical guidelines recommend that smoking, nutrition, alcohol consumption, physical activity and gestational weight gain (SNAP-W) be addressed as part of routine antenatal care throughout pregnancy. However, guideline recommendations are poorly implemented, and few antenatal care recipients routinely receive the recommended care. There is a need to establish the determinants (barriers and enablers) to care delivery to inform strategies to improve implementation. This systematic review aimed to synthesize qualitative and quantitative evidence of the barriers and enablers to the routine delivery of antenatal care targeting SNAP-W health risks.
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases were searched for relevant studies published between January 2001 and November 2023. Study findings were coded and analysed according to the domains of the Theoretical Domains Framework (TDF).
Forty-nine studies were included in the review, 27 qualitative studies and 22 quantitative studies. The studies were conducted in 14 countries. Data were collected from 7146 antenatal care providers (midwives, Aboriginal health workers, obstetricians, medical officers, general practitioners) and 352 barriers and enablers were identified. Across all SNAP-W health risk and antenatal care provider groups, the predominant TDF domain was 'environmental context and resources', identified in 96% of studies. Barriers within this domain included insufficient time, limited access to and quality of resources, and limited organisational supports. 'Beliefs about consequences' was the second most common TDF domain, reported in 67% of studies, particularly studies of care related to alcohol use, nutrition/ physical activity/ gestational weight gain and those involving midwives, multidisciplinary practitioners and general practitioners. 'Optimism' was the second most common TDF domain for studies of smoking-related care and involving obstetricians, gynaecologists, and other mixed medical professions.
It is critical that determinants related to environmental context and resources including time, resources and organisational supports are considered in the development of strategies to support the implementation of recommended antenatal care related to SNAP-W risks. Strategies addressing clinician beliefs about consequences and optimism may also be needed to support the implementation of care related to specific health behaviours and by specific antenatal care provider groups.
The review protocol was prospectively registered with Prospero: CRD42022353084; 22 October 2022.
国际临床指南建议，在整个孕期的常规产前护理中应涉及吸烟、营养、饮酒、身体活动和孕期体重增加（SNAP-W）等方面。然而，指南建议的实施情况很差，很少有接受产前护理的人能常规获得推荐的护理。有必要确定护理提供的决定因素（障碍和促进因素），为改善实施的策略提供依据。本系统评价旨在综合针对SNAP-W健康风险的产前护理常规提供的障碍和促进因素的定性和定量证据。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。检索了七个数据库，以查找2001年1月至2023年11月期间发表的相关研究。根据理论领域框架（TDF）的领域对研究结果进行编码和分析。
该评价纳入了49项研究，27项定性研究和22项定量研究。这些研究在14个国家进行。从7146名产前护理提供者（助产士、原住民卫生工作者、产科医生、医务人员、全科医生）收集了数据，并确定了352个障碍和促进因素。在所有SNAP-W健康风险和产前护理提供者群体中，主要的TDF领域是“环境背景和资源”，在96%的研究中被确定。该领域的障碍包括时间不足、资源获取和质量有限以及组织支持有限。“对后果的信念”是第二常见的TDF领域，在67%的研究中有所报告，特别是关于饮酒、营养/身体活动/孕期体重增加相关护理的研究，以及涉及助产士、多学科从业者和全科医生的研究。“乐观主义”是与吸烟相关护理研究以及涉及产科医生、妇科医生和其他混合医学专业的研究中第二常见的TDF领域。
在制定支持实施与SNAP-W风险相关的推荐产前护理的策略时，考虑与环境背景和资源相关的决定因素，包括时间、资源和组织支持至关重要。可能还需要解决临床医生对后果和乐观主义信念的策略，以支持与特定健康行为相关的护理实施以及特定产前护理提供者群体的护理实施。
该评价方案已在国际前瞻性系统评价注册库（Prospero）前瞻性注册：CRD42022353084；2022年10月22日。
