From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania
Objective To improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators.Design A formative research study was conducted in Romania between November 2019 and February 2020 by me...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-02-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/2/e065004.full |
| _version_ | 1797269207822368768 |
|---|---|
| author | Ana Pilar Betran Nino Berdzuli Alba Llop-Gironés Dana Farcasanu Cassandra Butu Miljana Grbic |
| author_facet | Ana Pilar Betran Nino Berdzuli Alba Llop-Gironés Dana Farcasanu Cassandra Butu Miljana Grbic |
| author_sort | Ana Pilar Betran |
| collection | DOAJ |
| description | Objective To improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators.Design A formative research study was conducted in Romania between November 2019 and February 2020 by means of in-depth interviews and focus-group discussions. Romanian decision-makers and high-level obstetricians preselected seven non-clinical interventions for consideration. Thematic content analysis was carried out.Participants 88 women and 26 healthcare providers and administrators.Settings Counties with higher and lower CS rates were selected for this research—namely Argeș, Bistrița-Năsăud, Brașov, Ialomița, Iași, Ilfov, Dolj and the capital city of București (Bucharest).Results Women wanted information, education and support. Obstetricians feared malpractice lawsuits; this was identified as a key reason for performing CSs. Most obstetrics and gynaecology physicians would oppose policies of mandatory second opinions, financial measures to equalise payments for vaginal and CS births and goal setting for CS rates. In-service training was identified as a need by obstetricians, midwives and nurses. In addition, relevant structural constraints were identified: perceived lower quality of care for vaginal birth, a lack of obstetricians with expertise in managing complicated vaginal births, a lack of anaesthesiologists and midwives, and family doctors not providing antenatal care. Finally, women expressed the need to ensure their rights to dignified and respectful healthcare through pregnancy and childbirth.Conclusion Consideration of the views, values and preferences of all stakeholders in a multifaceted action tailored to Romanian determinants is critical to address relevant determinants to reduce unnecessary CSs. Further studies should assess the effect of multifaceted interventions. |
| first_indexed | 2024-03-07T20:01:31Z |
| format | Article |
| id | doaj.art-cbdbd527f4ec4e9992bffc8f344d8550 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-25T01:44:43Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-cbdbd527f4ec4e9992bffc8f344d85502024-03-07T23:25:07ZengBMJ Publishing GroupBMJ Open2044-60552024-02-0114210.1136/bmjopen-2022-065004From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in RomaniaAna Pilar Betran0Nino Berdzuli1Alba Llop-Gironés2Dana Farcasanu3Cassandra Butu4Miljana Grbic5Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandCountry Health Programs, World Health Organization Regional Office for Europe, Copenhagen, DenmarkCountry Health Programs, World Health Organization Regional Office for Europe, Copenhagen, DenmarkCentre for Health Policies and Services, Bucharest, RomaniaWorld Health Organization Country Office for Romania, Copenhagen, DenmarkWorld Health Organization Country Office for Romania, Bucharest, RomaniaObjective To improve understanding of the drivers of the increased caesarean section (CS) rate in Romania and to identify interventions to reverse this trend, as well as barriers and facilitators.Design A formative research study was conducted in Romania between November 2019 and February 2020 by means of in-depth interviews and focus-group discussions. Romanian decision-makers and high-level obstetricians preselected seven non-clinical interventions for consideration. Thematic content analysis was carried out.Participants 88 women and 26 healthcare providers and administrators.Settings Counties with higher and lower CS rates were selected for this research—namely Argeș, Bistrița-Năsăud, Brașov, Ialomița, Iași, Ilfov, Dolj and the capital city of București (Bucharest).Results Women wanted information, education and support. Obstetricians feared malpractice lawsuits; this was identified as a key reason for performing CSs. Most obstetrics and gynaecology physicians would oppose policies of mandatory second opinions, financial measures to equalise payments for vaginal and CS births and goal setting for CS rates. In-service training was identified as a need by obstetricians, midwives and nurses. In addition, relevant structural constraints were identified: perceived lower quality of care for vaginal birth, a lack of obstetricians with expertise in managing complicated vaginal births, a lack of anaesthesiologists and midwives, and family doctors not providing antenatal care. Finally, women expressed the need to ensure their rights to dignified and respectful healthcare through pregnancy and childbirth.Conclusion Consideration of the views, values and preferences of all stakeholders in a multifaceted action tailored to Romanian determinants is critical to address relevant determinants to reduce unnecessary CSs. Further studies should assess the effect of multifaceted interventions.https://bmjopen.bmj.com/content/14/2/e065004.full |
| spellingShingle | Ana Pilar Betran Nino Berdzuli Alba Llop-Gironés Dana Farcasanu Cassandra Butu Miljana Grbic From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania BMJ Open |
| title | From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania |
| title_full | From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania |
| title_fullStr | From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania |
| title_full_unstemmed | From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania |
| title_short | From evidence to tailored decision-making: a qualitative research of barriers and facilitating factors for the implementation of non-clinical interventions to reduce unnecessary caesarean section in Romania |
| title_sort | from evidence to tailored decision making a qualitative research of barriers and facilitating factors for the implementation of non clinical interventions to reduce unnecessary caesarean section in romania |
| url | https://bmjopen.bmj.com/content/14/2/e065004.full |
| work_keys_str_mv | AT anapilarbetran fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania AT ninoberdzuli fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania AT alballopgirones fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania AT danafarcasanu fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania AT cassandrabutu fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania AT miljanagrbic fromevidencetotailoreddecisionmakingaqualitativeresearchofbarriersandfacilitatingfactorsfortheimplementationofnonclinicalinterventionstoreduceunnecessarycaesareansectioninromania |