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Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study.

Semenic S, Edwards N, Premji S, Olson J, Williams B, Montgomery P - BMC Pregnancy Childbirth (2015)

Bottom Line: Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities.The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada. sonia.semenic@mcgill.ca.

ABSTRACT

Background: Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada.

Methods: Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2.

Results: Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.

Conclusions: Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

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Overview of project phases and participants.
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Fig1: Overview of project phases and participants.

Mentions: The project involved two data collection phases and a dissemination phase (see Figure 1). Phase 1 comprised descriptive key informant interviews with prenatal record committee (PRC) leaders across 10 Canadian jurisdictions. Phase 2 involved a qualitative comparative case study of PRC decision-making in five of the 10 jurisdictions. Phase 3 consisted of a dissemination workshop with key stakeholders to review project recommendations arising from phase 1 and 2 data analysis. Ethics approval for the project was obtained from the Research Ethics Boards at each of the study co-investigators’ affiliated university (i.e., University of Ottawa, McGill University, University of Calgary, University of Alberta and Laurentian University). All interviewees in Phases 1 and 2 provided written informed consent prior to their participation. Phase 1 and 2 interviews were conducted between June 2008 and March 2009, and the dissemination workshop was held in March 2010.Figure 1


Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study.

Semenic S, Edwards N, Premji S, Olson J, Williams B, Montgomery P - BMC Pregnancy Childbirth (2015)

Overview of project phases and participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389923&req=5

Fig1: Overview of project phases and participants.
Mentions: The project involved two data collection phases and a dissemination phase (see Figure 1). Phase 1 comprised descriptive key informant interviews with prenatal record committee (PRC) leaders across 10 Canadian jurisdictions. Phase 2 involved a qualitative comparative case study of PRC decision-making in five of the 10 jurisdictions. Phase 3 consisted of a dissemination workshop with key stakeholders to review project recommendations arising from phase 1 and 2 data analysis. Ethics approval for the project was obtained from the Research Ethics Boards at each of the study co-investigators’ affiliated university (i.e., University of Ottawa, McGill University, University of Calgary, University of Alberta and Laurentian University). All interviewees in Phases 1 and 2 provided written informed consent prior to their participation. Phase 1 and 2 interviews were conducted between June 2008 and March 2009, and the dissemination workshop was held in March 2010.Figure 1

Bottom Line: Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities.The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

View Article: PubMed Central - PubMed

Affiliation: School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada. sonia.semenic@mcgill.ca.

ABSTRACT

Background: Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada.

Methods: Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2.

Results: Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.

Conclusions: Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

Show MeSH