Knowledge, attitudes and use of evidence-based practice among midwives in Belgium: A cross-sectional survey

Using digital technologies and applications in midwifery practice in Belgium: A descriptive cross-sectional study

INTRODUCTION

Over the past two decades, there has been a dramatic increase in the use of digital technologies within healthcare and also in midwifery. However, scarce literature exist on the use of digital technologies and applications in midwifery practice particularly in the Belgian setting.

AIM

To map the use of digital technologies and applications by midwives in various settings, encompassing hospitals, primary care, and educational institutions in Belgium.

METHODS

A descriptive cross-sectional design was used to collect data via an online questionnaire targeting at midwives working in the Flemish region, Walloon region, or Brussels-Capital region. Midwives were either Dutch-speaking or French-speaking (n = 212). The semi-structured questionnaire addressed three domains: (1) socio-demographics, (2) employment information (3) the use of digital technology, including the level of comfort with technology. Qualtrics© program was used for managing data and SPSS v28.0© for data analysis using descriptive statistics, Chi² analysis, and independent sample t-test. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines.

RESULTS

Among respondents, 58% reported the use of digital technologies and applications, with electronic health records (89.6%), electronic prescriptions (65.6%), and remote patient monitoring (51.2%) commonly utilized. Sensor technology (7.2%), mixed care (3.8%), care robots (2.5%), and wearable devices (1.9%) were very rarely used. The target groups for these digital technologies and applications generally encompass all stages of the perinatal period. Midwives felt overall highly confident with these technologies. Younger participants and those with a Master's or PhD degree exhibited greater comfort scores in digital technology use. No significant relationships were observed between socio-demographic characteristics and the adoption of digital technology.

CONCLUSION

The results highlight the potential for incorporating digital technologies and applications into various midwifery care settings. Addressing barriers and enhancing usability can optimize technology integration, contributing to personalized high-quality care, ultimately improving perinatal health outcomes.

Effect of midwives' attitudes towards evidence-based practices on mothers' perceptions regarding childbirth practices and satisfaction

OBJECTIVE

The aim was to determine the effect of midwives' attitudes towards evidence-based practices in childbirth on mothers' perception and satisfaction with childbirth practices.

MATERIAL AND METHOD

This cross-sectional study was carried out with the participation of 34 midwives working in the delivery rooms of three public hospitals in a province in the south of Türkiye and 287 postpartum women whose deliveries were facilitated by these midwives. A Personal Information Form and the Midwives' Evidence-Based Practices Attitude Scale during Labor (MEBPAS) were administered to the midwives. A Personal Information Form, the Birth Practices Perception Scale (BPPS), and the Birth Satisfaction Scale-Revised (BSS-R) were administered to the postpartum women.

RESULTS

Because the skewness and kurtosis values were between -2 and + 2, the data showed normal distribution. The multiple linear regression model showed that the dimensions of MEBPAS (Interventional Practices, Supportive Care Practices, Movement and Nutrition Practices, Early Postpartum Period Practices) explained 29.4% of the total variance in BSS-R (F = 30.798; p = 0.041) and 53.4% of the total variance in BPPS (F = 83.094; p < 0.001). According to the Structural Equation Modeling, Interventional Practices, Movement and Nutrition Practices, and Early Postpartum Period Practices had statistically significant positive effects on BSS-R (respectively, β = 0.286, p < 0.001; β = 0.479, p = 0.016, and β = 1.009, p < 0.001), while Interventional Practices, Supportive Care Practices, and Early Postpartum Period Practices had statistically significant negative effects on BPPS (respectively, β=-0.048, p < 0.001; β=-0.026, p = 0.027, and β=-0.039, p = 0.034).

CONCLUSION

It was found that midwives' positive attitudes towards evidence-based practices in childbirth positively affected women's perceptions and satisfaction with birth practices.

Uptake of evidence-based practice and its predictors among nurses in Ethiopia: a systematic review and meta-analysis

Background: While evidence-based practice has demonstrated its capacity to enhance healthcare quality and bolster clinical outcomes, the translation of research into clinical practice encounters persistent challenges. In Ethiopia, there remains a dearth of comprehensive and nationally representative data concerning the extent of Evidence-based practice adoption among nurses. Thus, this systematic review and meta-analysis endeavors to assess the overall prevalence of Evidence-based practice implementation and delve into its determinants among Ethiopian nurses. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. In order to identify pertinent studies, a search was conducted across PubMed, Scopus, Google Scholar, and EMBASE databases. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence. Cochrane's Q-test and I2 statistics were calculated to assess heterogeneity among studies. Funnel plots and Egger's test were utilized to evaluate publication bias. Pooled implementation rates and meta-regression analysis were carried out using STATA 17. Results: Of the total 1,590 retrieved articles, twelve studies including 4,933 nurses were included in the final analysis. The pooled prevalence of Evidence-based practice uptake among nurses in Ethiopia is 53% (95% CI: 46%-60%). Having knowledge about Evidence-based practice (AOR = 2.29; 95% CI: 1.90, 2.69; I2 = 70.95%), holding a favorable attitude towards Evidence-based practice (AOR = 2.56; 95% CI: 1.63, 3.49; I2 = 88.39%), occupying a head nurse position (AOR = 3.15; 95% CI: 1.85, 4.46; I2 = 87.42%), possessing effective communication skills (AOR = 4.99; 95% CI: 1.47, 8.51; I2 = 99.86%), and having access to Evidence-based practice guidelines (AOR = 1.90; 95% CI: 1.55, 2.24; I2 = 57.24%) were identified as predictors of the uptake of Evidence-based practice. Conclusion: Only half of Ethiopia's nurses exhibit a strong embrace of Evidence-Based Practice within clinical settings, underscoring the urgent necessity for coordinated endeavors to cultivate this essential practice. Possessing knowledge, effective communication skills, access to updated guidelines, maintaining a positive attitude towards Evidence-Based Practice, and holding a position as head nurse emerged as predictors of successful implementation of Evidence-Based Practice. Hence, policymakers must prioritize capacity-building initiatives, disseminate the latest EBP guidelines widely, and strengthen mentorship roles for head nurses. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42023488943.

Exploring Professional Practice Environments and Organisational Context Factors Affecting Nurses' Adoption of Evidence-Based Practice: A Scoping Review

This scoping review, conducted within the Joanna Briggs Institute (JBI) framework, analysed the recent literature (January 2018 to March 2023) addressing factors inherent to professional practice environments and organisational contexts influencing nurses' adoption of evidence-based practice (EBP). This review included studies involving nurses regardless of sector, practice setting, and scope of practice. A systematic search was undertaken across the PubMed, Web of Science, CINAHL, and MEDLINE databases, as well as the EThOS, OATD, and RCAAP platforms. The extracted textual elements underwent a content analysis, resulting in a coding structure established through an inductive approach that categorised information into main categories and subcategories linked by similarity and thematic affinity. Forty-one studies were included, revealing four main categories of factors impacting EBP adoption by nurses: (1) organisational dynamics, (2) management and leadership, (3) teamwork and communication, and (4) resources and infrastructure. The study's limitations acknowledge the subjective nature of categorisation, recognising potential variations based on individual perspectives despite adopting procedures to minimise the risk of bias. The results provide a substantial foundation for developing interventions to cultivate environments conducive to EBP adoption by nurses, thereby enhancing the integration of evidence into nurses' professional practice contexts. This review was prospectively registered on the Open Science Framework (registration no. osf.io/e86qz).

Strategies used by midwives to support prenatal physical activity: A scoping review

CONTEXT

Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations.

OBJECTIVE

To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations.

METHOD

A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted.

RESULTS

A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing.

CONCLUSION

Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice.

Key Maternity Care Stakeholders' Views on Midwives' Professional Autonomy

Advancement towards the professionalism of midwifery is closely linked to midwives' professional autonomy. Although the perspectives of Belgian midwives on their professional autonomy have been studied, the views of other maternity care stakeholders are a blind spot. The aim of this study, therefore, was to explore maternity care stakeholders' views on Belgian midwives' professional autonomy. A qualitative exploratory study was performed using focus group interviews. A heterogenous group of 27 maternity care stakeholders participated. The variation between midwives, with different levels of autonomy, was reported. The analysis of the data resulted in five themes: (1) The autonomous midwife is adequately educated and committed to continuous professional further education, (2) The autonomous midwife is competent, (3) The autonomous midwife is experienced, (4) The autonomous midwife assures safe and qualitative care, and (5) The autonomous midwife collaborates with all stakeholders in maternity care. A maternity collaborative framework, where all maternity care professionals respect each other's competences and autonomy, is crucial for providing safe and quality care. To achieve this, it is recommended to implement interprofessional education to establish strong foundations for interprofessional collaboration. Additionally, a regulatory body with supervisory powers can help ensure safe and quality care, while also supporting midwives' professional autonomy and professionalisation.