Experiences of skilled birth attendants with dissemination strategies and use of maternal clinical guidelines: A qualitative synthesis

Despite several evidence-based clinical guidelines aimed at improving the quality of maternal care as well as avert maternal mortality, guidelines frequently fail to reach the intended users. This qualitative synthesis explored experiences of Skilled Birth Attendants (SBAs) dissemination strategies and use of Maternal Clinical Guidelines (MCGs) by SBAs within the primary health care settings. Studies focusing on experiences of dissemination and use of evidence-based MCGs by SBAs were included. Further, it included studies published in English and those conducted between 2010–2023. A search was conducted using search terms “Maternal clinical guidelines “Dissemination” “Use” “Implementation” “Skilled birth attendants” “experiences or perceptions or attitudes or views or feelings or qualitative or perspective”. The search was done via Hinari and EBSCOhost in; Medline, PubMed, CINAHL. Additionally, searches were conducted using reference lists of the selected papers. Grey literature was searched from library repository and google scholar for further information. Search articles were uploaded in Mendeley, and duplicates removed. We included qualitative studies (10), mixed methods studies (5) and two (2) qualitative systematic syntheses because of paucity in qualitative only articles. Johanna Briggs Institute (JBI) Sumari appraisal tool was used to conduct the appraisal. All the articles included in this study were all imported to ATLAS ti for data management. The articles were code, grouped and themes developed. Three themes emerged: Dissemination strategies of MCGs, Use of MCGs (SBAs health systems factors), Improved utilization of maternal clinical guidelines. The findings of this study show experience in terms of facilitators and barriers to dissemination and use of guidelines. The study found Guidelines factors, Health systems factors, Skilled birth attendants’ factors and Community factors as the main facilitators and barriers for dissemination and use of guidelines. Future primary research may focus on, dissemination methods, actual use, and the outcomes of use. Additionally, the importance of appropriate use of maternal clinical guidelines needs to be emphasized early in midwifery competency education and more emphasis during in-service education.