Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers
Abstract Background Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementatio...
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BMC
2025-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13108-7 |
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| author | Eva Farragher Laura A. Wall Olivia Wynne John Wiggers Jenna Hollis Luke Wolfenden Francesco Paolucci Justine Daly Carly Mallise John Attia Craig Pennell Maralyn Foureur Karen J. Campbell Melanie Kingsland |
| author_facet | Eva Farragher Laura A. Wall Olivia Wynne John Wiggers Jenna Hollis Luke Wolfenden Francesco Paolucci Justine Daly Carly Mallise John Attia Craig Pennell Maralyn Foureur Karen J. Campbell Melanie Kingsland |
| author_sort | Eva Farragher |
| collection | DOAJ |
| description | Abstract Background Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementation. However, no previous studies have identified which barriers are most important. Methods A best–worst scaling (BWS) survey was developed to estimate the magnitude and rank the importance of barriers to the delivery of recommended GWG care. The survey was conducted between December 2020 and November 2021 with ACPs (medical, midwifery, and Aboriginal health workers) who provided care in public maternity services within three sites in New South Wales, Australia. ACPs were asked to select which of four barriers were most and least likely to inhibit five recommended GWG care practices (assessment of GWG; advice on GWG, diet and physical activity; and referral to specialist GWG services). Rankings of barriers were determined through choice frequency analysis for ACPs at each site. Results A total of 143 ACPs completed the survey (64.4% response rate). For each of the five recommended GWG care practices, the most important barrier across all health sites and for both midwives and medical ACPs was ‘compared to other aspects of my job, the guideline care is not a high priority.’ There was some variation in the importance of barriers between sites. Across all sites, medical staff were more likely than midwives to report ‘I forget’ as a barrier to weighing and providing weight tracking and dietary advice and ‘I don’t feel confident (providing this GWG care practice)’ as a barrier to providing referrals to a specialist GWG service. Conclusions Best–worst scaling was a valuable method to rank the influence of barriers and to prioritise site-specific and profession-based barriers to ACP provision of guideline-recommended care for GWG. Not all barriers were equally important, and this ‘hierarchy’ differed across ACPs and sites. Implementation strategies should be developed to address the highest priority barriers, tailored to site and professional needs. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021). http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true |
| format | Article |
| id | doaj-art-8d7c211ce3a54e7b9954da57f661de80 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-8d7c211ce3a54e7b9954da57f661de802025-08-20T03:42:40ZengBMCBMC Health Services Research1472-69632025-07-0125111510.1186/s12913-025-13108-7Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriersEva Farragher0Laura A. Wall1Olivia Wynne2John Wiggers3Jenna Hollis4Luke Wolfenden5Francesco Paolucci6Justine Daly7Carly Mallise8John Attia9Craig Pennell10Maralyn Foureur11Karen J. Campbell12Melanie Kingsland13Population Health, Hunter New England Local Health DistrictHunter Medical Research InstituteSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of NewcastlePopulation Health, Hunter New England Local Health DistrictPopulation Health, Hunter New England Local Health DistrictPopulation Health, Hunter New England Local Health DistrictNewcastle Business School, University of NewcastlePopulation Health, Hunter New England Local Health DistrictPopulation Health, Hunter New England Local Health DistrictSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of NewcastleSchool of Medicine and Public Health, College of Health Medicine and Wellbeing, The University of NewcastleHunter Medical Research InstituteCentre for Research Excellence, Early Prevention of Childhood Obesity (EPOCH), Deakin UniversityPopulation Health, Hunter New England Local Health DistrictAbstract Background Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementation. However, no previous studies have identified which barriers are most important. Methods A best–worst scaling (BWS) survey was developed to estimate the magnitude and rank the importance of barriers to the delivery of recommended GWG care. The survey was conducted between December 2020 and November 2021 with ACPs (medical, midwifery, and Aboriginal health workers) who provided care in public maternity services within three sites in New South Wales, Australia. ACPs were asked to select which of four barriers were most and least likely to inhibit five recommended GWG care practices (assessment of GWG; advice on GWG, diet and physical activity; and referral to specialist GWG services). Rankings of barriers were determined through choice frequency analysis for ACPs at each site. Results A total of 143 ACPs completed the survey (64.4% response rate). For each of the five recommended GWG care practices, the most important barrier across all health sites and for both midwives and medical ACPs was ‘compared to other aspects of my job, the guideline care is not a high priority.’ There was some variation in the importance of barriers between sites. Across all sites, medical staff were more likely than midwives to report ‘I forget’ as a barrier to weighing and providing weight tracking and dietary advice and ‘I don’t feel confident (providing this GWG care practice)’ as a barrier to providing referrals to a specialist GWG service. Conclusions Best–worst scaling was a valuable method to rank the influence of barriers and to prioritise site-specific and profession-based barriers to ACP provision of guideline-recommended care for GWG. Not all barriers were equally important, and this ‘hierarchy’ differed across ACPs and sites. Implementation strategies should be developed to address the highest priority barriers, tailored to site and professional needs. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021). http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=truehttps://doi.org/10.1186/s12913-025-13108-7BarriersPrioritisationImplementationBest–worst scalingAntenatal careGestational weight gain |
| spellingShingle | Eva Farragher Laura A. Wall Olivia Wynne John Wiggers Jenna Hollis Luke Wolfenden Francesco Paolucci Justine Daly Carly Mallise John Attia Craig Pennell Maralyn Foureur Karen J. Campbell Melanie Kingsland Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers BMC Health Services Research Barriers Prioritisation Implementation Best–worst scaling Antenatal care Gestational weight gain |
| title | Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers |
| title_full | Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers |
| title_fullStr | Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers |
| title_full_unstemmed | Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers |
| title_short | Implementing clinical guidelines for gestational weight gain care: a novel application of best–worst scaling to prioritise barriers |
| title_sort | implementing clinical guidelines for gestational weight gain care a novel application of best worst scaling to prioritise barriers |
| topic | Barriers Prioritisation Implementation Best–worst scaling Antenatal care Gestational weight gain |
| url | https://doi.org/10.1186/s12913-025-13108-7 |
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