Facilitators and Barriers to Implementation of Perineal Techniques: A Scoping Review Applying the Consolidated Framework for Implementation Research.

Abstract

Aim: To summarise the barriers and facilitators to the clinical implementation of perineal techniques and to provide evidence-based insights for decision-making based on existing research.

Design: A scoping review.

Data sources: Nine electronic databases (PubMed, Cochrane Library, Embase, CINAHL, ProQuest, CNKI, WanFang, VIP and SinoMed) were systematically searched on 4 February 2024.

Review methods: This study followed Joanna Briggs Institute's scoping review methodology. The barriers and facilitators identified in the included studies were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR): intervention characteristics, outer setting, inner setting, characteristics of individuals and process.

Results: A total of 18 studies were finally included and analysed. The most frequently identified facilitator was theoretical education for midwives (inner setting). Common barriers included: lack of time to implement perineal techniques (intervention characteristics); labour pain and women's stress due to insufficient understanding of the birthing process, as well as women's reluctance to receive the perineal techniques (outer setting); risk factors for OASIS (inner setting); insufficient theoretical education for midwives and inadequate prenatal education for pregnant women (inner setting) and concerns about potential medical disputes among performers (characteristics of individuals).

Conclusions: Many of the factors influencing the implementation of perineal techniques identified in this review are modifiable. Developing implementation strategies based on these factors can promote the successful implementation of these perineal techniques in clinical settings.

Implications for the profession: This scoping review could serve as a reference framework for health authorities in developing strategies to promote the use of perineal techniques in clinical practice.

Impact: Existing research has primarily focused on the outer setting, inner setting and characteristics of individuals implementing perineal techniques. Therefore, there is a need for more high-quality studies focusing on intervention characteristics and the implementation process.

Reporting method: This study followed the PRISMA extension for scoping reviews.

Patient and public contribution: Not applicable.