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Type: Journal article
Title: Barriers and enablers to implementing antenatal magnesium sulphate for fetal neuroprotection guidelines: a study using the theoretical domains framework
Author: Bain, E.
Bubner, T.
Ashwood, P.
Van Ryswyk, E.
Simmonds, L.
Reid, S.
Middleton, P.
Crowther, C.
Citation: BMC Pregnancy and Childbirth, 2015; 15(1):176-1-176-11
Publisher: BioMed Central
Issue Date: 2015
ISSN: 1471-2393
Statement of
Emily Bain, Tanya Bubner, Pat Ashwood, Emer Van Ryswyk, Lucy Simmonds, Sally Reid, Philippa Middleton and Caroline A. Crowther
Abstract: BACKGROUND: Strong evidence supports administration of magnesium sulphate prior to birth at less than 30 weeks' gestation to prevent very preterm babies dying or developing cerebral palsy. This study was undertaken as part of The WISH (Working to Improve Survival and Health for babies born very preterm) Project, to assess health professionals' self-reported use of antenatal magnesium sulphate, and barriers and enablers to implementation of 2010 Australian and New Zealand clinical practice guidelines. METHODS: Semi-structured, one-to-one interviews were conducted with obstetric and neonatal consultants and trainees, and midwives in 2011 (n = 24) and 2012-2013 (n = 21) at the Women's and Children's Hospital, South Australia. Transcribed interview data were coded using the Theoretical Domains Framework (describing 14 domains related to behaviour change) for analysis of barriers and enablers. RESULTS: In 2012-13, health professionals more often reported 'routinely' or 'sometimes' administering or advising their colleagues to administer magnesium sulphate for fetal neuroprotection (86% in 2012-13 vs. 46% in 2011). 'Knowledge and skills', 'memory, attention and decision processes', 'environmental context and resources', 'beliefs about consequences' and 'social influences' were key domains identified in the barrier and enabler analysis. Perceived barriers were the complex administration processes, time pressures, and the unpredictability of preterm birth. Enablers included education for staff and women at risk of very preterm birth, reminders and 'prompts', simplified processes for administration, and influential colleagues. CONCLUSIONS: This study has provided valuable data on barriers and enablers to implementing magnesium sulphate for fetal neuroprotection, with implications for designing and modifying future behaviour change strategies, to ensure optimal uptake of this neuroprotective therapy for very preterm infants.
Keywords: Humans
Cerebral Palsy
Premature Birth
Magnesium Sulfate
Neuroprotective Agents
Attitude of Health Personnel
Time Factors
Clinical Competence
Reminder Systems
Infant, Newborn
Infant, Premature
Guideline Adherence
South Australia
Practice Guidelines as Topic
Infant, Extremely Premature
Perinatal Death
Rights: © 2015 Bain et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/s12884-015-0618-9
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