Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines.
BACKGROUND
The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand) antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework.


METHODS
Semi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored.


RESULTS
Seventy-three health professionals completed either a semi-structured interview (n = 35) or on-line questionnaire (n = 38). Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities.


CONCLUSION
This study has identified some of the enablers and barriers to implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines using the validated Theoretical Domains Framework, as perceived by health professionals. We have identified differences between individual health professional groups and organisations. The identification of these behavioural determinants can be used to enhance an implementation strategy, assist in the design of interventions to achieve improved implementation and facilitate process evaluations to understand why or how change interventions are effective.
['Mc Goldrick|E L|EL|', 'Crawford|T|T|', 'Brown|J A|JA|', 'Groom|K M|KM|', 'Crowther|C A|CA|']
D000305:Adrenal Cortex Hormones D000328:Adult D001291:Attitude of Health Personnel D001315:Australia D055317:Evidence-Based Practice D005260:Female D019983:Guideline Adherence D007722:Health Knowledge, Attitudes, Practice D006282:Health Personnel D006801:Humans D008297:Male D008875:Middle Aged D009520:New Zealand D009936:Organizational Innovation D010465:Perception D017410:Practice Guidelines as Topic D011295:Prenatal Care D011364:Professional Practice D024382:Professional Role D055815:Young Adult
Implementation Antenatal corticosteroids Clinical practice guidelines Theoretical domains framework