Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec
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Authors
Chaillet, Nils; Dubé, Eric; Dugas, Marylène; Francoeur, Diane; Dubé, Johanne;Gagnon, Sonia; Poitras, Lucie;Dumont, Alexandre
Issue Date
2007
Type
Journal / periodical articles
Language
Keywords
Research
Alternative Title
Abstract
Description
Objective: To investigate obstetricians’ perceptions of clinical practice guidelines targeting management of labour and vaginal
birth after previous caesarean birth, and to identify the barriers to, facilitators of and obstetricians’ solutions for implementing these
guidelines in practice.
Methods: This qualitative study was conducted in three hospitals in Montreal that represent around 10% of births in Quebec.
Data was collected from 10 focus groups, followed by six semi-structured interviews. Two researchers jointly analysed the verbatim
transcripts according to
A manual for the use of focus groups.
Findings: The identified barriers to and facilitators of the implementation of guidelines can be classified into four categories:
1) the hospital level, including management and hospital policies; 2) the departmental level, including local policies, leadership,
organizational factors, economic incentive, and availability of equipment and staff; 3) the health professionals’ motivations and
attitudes, including medico-legal concerns, skill levels, acceptance of guidelines and strategies used to implement recommendations;
and 4) patients’ motivations.
Conclusion: Identifying the barriers to and facilitators of the adoption of recommendations is an important way to guide the
development of efficient strategies.The findings of this study suggest that the adoption of guidelines may be improved if local health
professionals’ perceptions are considered to make recommendations more acceptable and useful. Our findings also support the
assumption that obstetricians seek to implement best practices, but require evidence tools and support to assess their practices and
enhance their performance. In addition, peer review activities championed by opinion leaders have been identified by obstetricians
as the most suitable strategy to improve the use of the guidelines in their practices.
Citation
Publisher
WHO