Lessons from using the Normalisation Process Theory to understand adherence to guidance on MgSO₄ in preterm labour

Area of Science:

• Obstetrics and Gynecology
• Neonatal Neurology
• Health Services Research

Background:

• Magnesium sulphate (MgSO4) is recommended by NICE for neuroprotection in preterm labour.
• Uptake of MgSO4 varies across UK maternity units.
• This study investigates knowledge mobilisation for scaling MgSO4 implementation.

Purpose of the Study:

• To understand how knowledge mobilisation drives the scaling and spread of MgSO4 implementation for infant neuroprotection.
• To identify factors influencing the uptake of evidence-based interventions in maternity care.

Main Methods:

• Semi-structured interviews with 86 strategic and clinical leads across England, Scotland, and Wales.
• Utilised Normalisation Process Theory for data collection and analysis.
• Employed the framework method for qualitative data analysis.

Main Results:

• Audit data and benchmarking, alongside evidence, motivated improvement interventions.
• Knowledge sharing, innovation diffusion, and capacity building via networks drove scaling.
• Local champions acted as boundary-spanners, facilitating knowledge mobilisation with protected time and resources.

Conclusions:

• Knowledge mobilisation in quality improvement (QI) interventions can scale and spread best practices.
• Effective scaling requires knowledge sharing, supportive infrastructure, and capacity building.
• Strong leadership, addressing power dynamics, and funding for champions are crucial.