Evaluación de la implantación de la Guía de Buenas Prácticas “Lactancia Materna” de la Asociación Profesional de Enfermeras de Ontario (RNAO), en el Área III de Salud de la Comunidad Autónoma de la Región de Murcia

Abstract

Evidence-Based Practice is currently assumed as a methodological paradigm that helps health professionals in decision-making. Clinical Practice Guidelines (CPG) are tools that facilitate the professional to incorporate scientific evidence into daily clinical practice. The Health Area III of the Autonomous Community of the Region of Murcia in 2011 submitted a proposal to the international program Best Practice Spotlight Organizations (BPSO¿) for the implementation of CPGs, developed by the Registered Nurses Association of Ontario (RNAO¿). The application was approved and 5 CPGs were implemented during the years 2012-2015, one of them regarding Breastfeeding (BF). The main objective of this Doctoral Thesis was to evaluate the implementation process of the RNAO Breastfeeding CPG in the context of the BPSO¿ implementation program. The specific objectives were: to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals adopting a Theory of Planned Behavior approach, to examine the perceptions and experiences of health care professionals and mothers in relation to the implementation of a breastfeeding clinical practice guide- line, to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines for breastfeeding under the auspices of the Best Practice Spotlight Organization program. It has been organized in three research studies, one cross-sectional observational study and two qualitative studies. In the first one, we aimed to determine the effect of Breastfeeding CPG implementation on the factors associated with breastfeeding support by professionals, while with the qualitative studies we wanted to know the perceptions and experiences of the people involved in the implementation of the guide and identify the barriers found throughout the process. The study population was made up of professionals and users of Health Area III. In the cross-sectional study, a validated questionnaire was used to assess health professionals' attitudes, beliefs, knowledge, subjective norms, and behavioral intentions about breastfeeding support. In the qualitative studies, semi-structured interviews were carried out to understand the experiences of whom were involved in the CPG implementation process. The results showed an increase in the degree of breastfeeding support from health professionals in Health Area III, as well as differences in participation in the implantation, according to the role or profile of the professional and the degree of commitment to the CPG process. The barriers detected were linked to the lack of human, material and economic resources; the places where the implantation took place and the characteristics of those who did it. Other barriers were their relationships with each other; the lack of dissemination and scope of the project to professionals and the sociocultural factors related to the mother and her environment. The main conclusion is that the implementation of the RNAO Breastfeeding CPG in Health Area III of the Autonomous Community of the Region of Murcia has meant a complex process for all the actors involved, in which multi-component interventions have been carried out, requiring constant adaptation to changing barriers and environments. Variability in clinical practice has been reduced due to the unification of criteria and standardization of care related significant improvements in the breastfeeding support. In conclusion, understanding the role of each of the participants during the process and finding barriers have facilitated the CPG implementation process at the organizational level, being useful for both professionals and users.