Factors influencing appropriate use of interventions for management of women experiencing preterm birth: A mixed-methods systematic review and narrative synthesis Article Swipe
Rana Islamiah Zahroh
,
Alya Hazfiarini
,
Katherine E. Eddy
,
Joshua P. Vogel
,
Özge Tunçalp
,
Nicole Minckas
,
Fernando Althabe
,
Olufemi T. Oladapo
,
Meghan A. Bohren
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pmed.1004074
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1371/journal.pmed.1004074
Background Preterm birth-related complications are the leading cause of death in newborns and children under 5. Health outcomes of preterm newborns can be improved with appropriate use of antenatal corticosteroids (ACSs) to promote fetal lung maturity, tocolytics to delay birth, magnesium sulphate for fetal neuroprotection, and antibiotics for preterm prelabour rupture of membranes. However, there are wide disparities in the rate and consistency in the use of these interventions across settings, which may underlie the differential health outcomes among preterm newborns. We aimed to assess factors (barriers and facilitators) affecting the appropriate use of ACS, tocolytics, magnesium sulphate, and antibiotics to improve preterm birth management. Methods and findings We conducted a mixed-methods systematic review including primary qualitative, quantitative, and mixed-methods studies. We searched MEDLINE, EMBASE, CINAHL, Global Health, and grey literature from inception to 16 May 2022. Eligible studies explored perspectives of women, partners, or community members who experienced preterm birth or were at risk of preterm birth and/or received any of the 4 interventions, health workers providing maternity and newborn care, and other stakeholders involved in maternal care (e.g., facility managers, policymakers). We used an iterative narrative synthesis approach to analysis, assessed methodological limitations using the Mixed Methods Appraisal Tool, and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. Behaviour change models (Theoretical Domains Framework; Capability, Opportunity, and Motivation (COM-B)) were used to map barriers and facilitators affecting appropriate use of these interventions. We included 46 studies from 32 countries, describing factors affecting use of ACS (32/46 studies), tocolytics (13/46 studies), magnesium sulphate (9/46 studies), and antibiotics (5/46 studies). We identified a range of barriers influencing appropriate use of the 4 interventions globally, which include the following: inaccurate gestational age assessment, inconsistent guidelines, varied knowledge, perceived risks and benefits, perceived uncertainties and constraints in administration, confusion around prescribing and administering authority, and inadequate stock, human resources, and labour and newborn care. Women reported hesitancy in accepting interventions, as they typically learned about them during emergencies. Most included studies were from high-income countries (37/46 studies), which may affect the transferability of these findings to low- or middle-income settings. Conclusions In this study, we identified critical factors affecting implementation of 4 interventions to improve preterm birth management globally. Policymakers and implementers can consider these barriers and facilitators when formulating policies and planning implementation or scale-up of these interventions. Study findings can inform clinical preterm birth guidelines and implementation to ensure that barriers are addressed, and enablers are reinforced to ensure these interventions are widely available and appropriately used globally.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1371/journal.pmed.1004074
- OA Status
- gold
- Cited By
- 21
- References
- 81
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4292767269
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4292767269Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1371/journal.pmed.1004074Digital Object Identifier
- Title
-
Factors influencing appropriate use of interventions for management of women experiencing preterm birth: A mixed-methods systematic review and narrative synthesisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2022Year of publication
- Publication date
-
2022-08-23Full publication date if available
- Authors
-
Rana Islamiah Zahroh, Alya Hazfiarini, Katherine E. Eddy, Joshua P. Vogel, Özge Tunçalp, Nicole Minckas, Fernando Althabe, Olufemi T. Oladapo, Meghan A. BohrenList of authors in order
- Landing page
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https://doi.org/10.1371/journal.pmed.1004074Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1371/journal.pmed.1004074Direct OA link when available
- Concepts
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Medicine, CINAHL, Psychological intervention, MEDLINE, Premature birth, Systematic review, Intensive care medicine, Pediatrics, Family medicine, Pregnancy, Obstetrics, Nursing, Gestational age, Law, Political science, Biology, GeneticsTop concepts (fields/topics) attached by OpenAlex
- Cited by
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21Total citation count in OpenAlex
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2025: 8, 2024: 6, 2023: 5, 2022: 2Per-year citation counts (last 5 years)
- References (count)
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81Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| corresponding_author_ids | https://openalex.org/A5085384499, https://openalex.org/A5056317757, https://openalex.org/A5077213908, https://openalex.org/A5055307100, https://openalex.org/A5046069650, https://openalex.org/A5034689420, https://openalex.org/A5034889366, https://openalex.org/A5034376558, https://openalex.org/A5075836945 |
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| corresponding_institution_ids | https://openalex.org/I145902186, https://openalex.org/I165779595, https://openalex.org/I4210105654 |
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| citation_normalized_percentile.is_in_top_10_percent | True |