Implementation of pregnancy weight management and obesity guidelines: a meta‐synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework

Abstract

Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.

Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

“…The use of the TDF for secondary analysis required some subjective interpretation due to the lack of contextual detail reported for some of the barriers and enablers. This limitation has been reported by other authors [21]. No included study used a behaviour change theory, standard taxonomy, or framework to interpret findings.…”

“…The TDF has also been used as a coding framework for the analysis of barriers in systematic reviews [20–22]. In one study the TDF allowed the researchers to explore, explain and potentially target, using sophisticated behaviour change interventions, complex relationships, for example, limited “knowledge” appeared to influence healthcare professional’s ‘emotions’ [21]. …”

Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes

“…These results align with similar findings from EMR interventions in other areas in showing that interventions like this one have potential to improve both prenatal care practice and patient outcomes (Klatt & Hopp, 2012; Sise, Chappelle, & Figueroa, 2012). This EMR intervention removes barriers that providers traditionally face when counseling patients about gestational weight gain (Heslehurst et al, 2014), i.e. it automatically calculates appropriate gestational weight gain goals for each unique patient based on pre-gravid BMI, fetal number, and IOM guidelines, it provides scripted messages to facilitate patient education and documentation, it provides prompts to counsel patients and screen early for Type 2 diabetes when warranted, and it changes organizational culture to make gestational weight gain patient education a normative part of prenatal care.…”

Diet and exercise in pregnancy

“…The challenge of interpreting research therefore is how to assess apparently positive effects of intervention when those effects are not statistically significant potentially as a result of inadequate sample size. Healthcare practitioners' scepticism about the value of interventions in pregnancy have been shown to be a barrier to implementation of weight management guidelines, 9 and difficulties interpreting the evidence may play a part in this.…”