Evaluating the application and clinical practice of adapted national preeclampsia and eclampsia guideline; a cross-sectional study from Iran.

Abstract

Background: Hypertensive disorders during pregnancy (HDP) are a significant cause of maternal mortality. The present study examined the extent of preeclampsia and eclampsia guideline use across different healthcare provider groups, aiming to provide evidence-based recommendations for better guideline implementation.

Methods: A cross-sectional study was conducted from 2021-10-04 to 2022-04-04. Participants were maternal health providers from 63 medical universities in the country. For evaluating clinical applicability of the guideline, an online questionnaire developed. Questionnaire was designed to evaluate the Implementation, Usability, Validity, Applicability, Accommodation, and Evaluation of national guideline. The mean score for each question was calculated and categorized in unfavorable, relatively favorable, and favorable values. The online questionnaire was delivered to the all-guideline users. The answered questionnaires were sent back to the research team after a week.

Results: Totally, 1,283 health care providers as the respondents completed the questionnaires. The ways to access the guideline that were expressed by the participants were: printed book in 57.9%, medical websites in 11.2%, CDs in 10.5%, and posters, bulletins, and brochures in 20.4%. The results delineated that general practitioner had the highest scores related to the majority of domains consisting of Implementation, Usability, Evaluation, and Validity than Behvarz (community health workers in the rural and urban healthcare centers), midwife, and obstetrician groups (p < 0.01). The results showed that mother's non-compliance, non-practical content of guideline, and lack of facilities were the most important reported challenges in guideline implementation.

Conclusion: To effectively enhance the national preeclampsia guideline, it is critical to adopt a structured approach based on feedback from diverse healthcare providers. Key areas identified for improvement include ensuring comprehensive guideline awareness through better distribution, enhancing usability by simplifying language and offering quick-reference tools, regularly updating the guideline with new research, adapting it for varied clinical environments, accommodating the specific needs of different provider groups, and establishing a continuous evaluation mechanism through feedback loops. These steps aim to refine the guideline's practicality, reliability, and comprehensiveness in managing preeclampsia across diverse healthcare settings.