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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Research

Investigating midwives’ barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework

Authors: Julie M. McLellan, Ronan E. O’Carroll, Helen Cheyne, Stephan U. Dombrowski

Published in: Implementation Science | Issue 1/2019

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Abstract

Background

In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes.

Methods

The research compromised of two studies.
Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes.
Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1.

Results

Midwives’ perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives’ cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives’ motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes.

Conclusions

Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed.
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Literature
1.
Finlay H. Public health, midwifery and government policy. In: Bowden J, Manning V, editors. Health promotion in midwifery principles and practice. Boca Raton: CRC Press; 2016. p. 1–18.
2.
3.
Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk J. On behalf of MBRRACE-UK. Saving lives, improving mothers’ care: lessons learned to inform future maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2009–2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014.
4.
5.
6.
Sanders J, Hunter B, Warren L. A wall of information? Exploring the public health component of maternity care in England. Midwifery. 2016;34:253–60.CrossRef
7.
McNeill J, Doran J, Lynn F, Anderson G, Alderdice F. Public health education for midwives and midwifery students: a mixed methods study. BMC Pregnancy Childbirth. 2012;12:142.CrossRef
8.
McNeill J, Lynn F, Alderdice F. Public health interventions in midwifery: a systematic review of systematic reviews. BMC Public Health. 2012;12:955.CrossRef
9.
Lavender T, Bennett N, Blundell J, Malpass L. Midwives' views on redefining midwifery 1: health promotion. Br J Midwifery. 2001;9:666–70.CrossRef
10.
Biro MA. What has public health got to do with midwifery? Midwives’ role in securing better health outcomes for mothers and babies. Women Birth. 2011;24:17–23.CrossRef
11.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14:26–33.CrossRef
12.
Beenstock J, Sniehotta FF, White M, Bell R, Milne EM, Araujo-Soares V. What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the north east of England. Implement Sci. 2012;7:36.CrossRef
13.
Heslehurst N, Newham J, Maniatopoulos G, Fleetwood C, Robalino S, Rankin J. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the theoretical domains framework. Obes Rev. 2014;15:462–86.CrossRef
14.
McParlin C, Bell R, Robson S, MuirHead C, Araujo-Soares V. What helps or hinders midwives to implement physical activity guidelines for obese women? A questionnaire survey using the theoretical domains framework. Midwifery. 2017;49:110–6.CrossRef
15.
Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRef
16.
Fishbein M. Attitude and the prediction of behavior. In: Fishbein M, editor. Readings in attitude theory and measurement. Oxford: Wiley; 1967. p. 477–91.
17.
Foy R, Francis JJ, Johnston M, Eccles M, Lecouturier J, Bamford C, Grimshaw J. The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia. BMC Health Serv Res. 2007;7:207.CrossRef
18.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef
19.
Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, Foy R, Duncan EM, Colquhoun H, Grimshaw JM, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:77.CrossRef
20.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRef
21.
Cahir C, Guinan E, Dombrowski SU, Sharp L, Bennett K. Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I–III breast cancer: a systematic review and meta-analysis. Patient Educ Couns. 2015;98:1524–39.CrossRef
22.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006;18:59–82.CrossRef
23.
Lawton R, Heyhoe J, Louch G, Ingleson E, Glidewell L, Willis TA, McEachan RR, Foy R. Using the theoretical domains framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study. Implement Sci. 2015;11:113.CrossRef
24.
Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the theoretical domains framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci. 2012;7:52.CrossRef
25.
Riediger M, Freund AM. Interference and facilitation among personal goals: differential associations with subjective well-being and persistent goal pursuit. Personal Soc Psychol Bull. 2004;30(12):1511–23.CrossRef
26.
Presseau J, Boyd E, Francis JJ, Sniehotta FF. Goal conflict and goal facilitation in community-based cardiac rehabilitation: a theory-based interview study. Psychol Health Med. 2015;20(2):227–38.CrossRef
27.
Fleig L, Ngo J, Roman B, Ntzani E, Satta P, Warner LM, Schwarzer R, Brandi ML. Beyond single behaviour theory: adding cross-behaviour cognitions to the health action process approach. Br J Health Psychol. 2015;20(4):824–41.CrossRef
Metadata
Title
Investigating midwives’ barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework
Authors
Julie M. McLellan
Ronan E. O’Carroll
Helen Cheyne
Stephan U. Dombrowski
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0913-3

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