Farragher Eva, Wall Laura A, Wynne Olivia, Wiggers John, Hollis Jenna, Wolfenden Luke, Paolucci Francesco, Daly Justine, Mallise Carly, Attia John, Pennell Craig, Foureur Maralyn, Campbell Karen J, 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.
BMC Health Serv Res. 2025 Jul 29;25(1):997. doi: 10.1186/s12913-025-13108-7.
Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementation. However, no previous studies have identified which barriers are most important.
A best-worst scaling (BWS) survey was developed to estimate the magnitude and rank the importance of barriers to the delivery of recommended GWG care. The survey was conducted between December 2020 and November 2021 with ACPs (medical, midwifery, and Aboriginal health workers) who provided care in public maternity services within three sites in New South Wales, Australia. ACPs were asked to select which of four barriers were most and least likely to inhibit five recommended GWG care practices (assessment of GWG; advice on GWG, diet and physical activity; and referral to specialist GWG services). Rankings of barriers were determined through choice frequency analysis for ACPs at each site.
A total of 143 ACPs completed the survey (64.4% response rate). For each of the five recommended GWG care practices, the most important barrier across all health sites and for both midwives and medical ACPs was 'compared to other aspects of my job, the guideline care is not a high priority.' There was some variation in the importance of barriers between sites. Across all sites, medical staff were more likely than midwives to report 'I forget' as a barrier to weighing and providing weight tracking and dietary advice and 'I don't feel confident (providing this GWG care practice)' as a barrier to providing referrals to a specialist GWG service.
Best-worst scaling was a valuable method to rank the influence of barriers and to prioritise site-specific and profession-based barriers to ACP provision of guideline-recommended care for GWG. Not all barriers were equally important, and this 'hierarchy' differed across ACPs and sites. Implementation strategies should be developed to address the highest priority barriers, tailored to site and professional needs.
Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021). http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true.
推荐提供孕期体重增加（GWG）护理的产前临床指南，产前护理提供者（ACPs）并未常规执行。确定此类护理实施的障碍可为制定针对性策略以促进实施提供依据。然而，以往尚无研究确定哪些障碍最为重要。
开展了一项最佳-最差尺度法（BWS）调查，以评估障碍的严重程度并对推荐的GWG护理实施障碍的重要性进行排序。该调查于2020年12月至2021年11月期间，对在澳大利亚新南威尔士州三个地点的公共产科服务机构提供护理的ACPs（医生、助产士和原住民卫生工作者）进行。要求ACPs从四个障碍中选择最有可能和最不可能阻碍五项推荐的GWG护理措施（GWG评估；GWG、饮食和体育活动建议；以及转介至GWG专科服务）的障碍。通过对每个地点的ACPs进行选择频率分析来确定障碍的排名。
共有143名ACPs完成了调查（回复率为64.4%）。对于五项推荐的GWG护理措施中的每一项，在所有医疗机构以及助产士和医生ACPs中，最重要障碍均为“与我工作的其他方面相比，指南护理并非高度优先事项”。不同地点障碍的重要性存在一些差异。在所有地点，医务人员比助产士更有可能将“我忘记了”作为称重及提供体重跟踪和饮食建议的障碍，以及将“我没有信心（提供此项GWG护理措施）”作为转介至GWG专科服务的障碍。
最佳-最差尺度法是一种评估障碍影响并对ACPs提供指南推荐的GWG护理的特定地点和基于专业的障碍进行优先排序的宝贵方法。并非所有障碍都同样重要，且这种“层级关系”因ACPs和地点而异。应制定实施策略以解决最高优先级障碍，并根据地点和专业需求进行调整。
澳大利亚和新西兰临床试验注册中心，ACTRN12621000054819（2021年1月22日）。http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true。
