An Evaluation of the Quality, Suitability and Impact on Equity of Clinical Practice Guidelines Relevant to Preterm Birth for Use in Aotearoa New Zealand

aut.relation.journalBMC Pregnancy and Childbirth
dc.contributor.authorHunter, B
dc.contributor.authorDawes, L
dc.contributor.authorWadsworth, M
dc.contributor.authorSadler, L
dc.contributor.authorEdmonds, L
dc.contributor.authorMcAra-Couper, J
dc.contributor.authorAllen-Mokaraka, T
dc.contributor.authorGroom, KM
dc.description.abstractBackground: Preterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required. Methods: Guidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology. Results: A total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations. Conclusions: We have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.
dc.identifier.citationBMC Pregnancy and Childbirth, ISSN: 1471-2393 (Print); 1471-2393 (Online), Springer Science and Business Media LLC, 24(1), 234-. doi: 10.1186/s12884-024-06415-0
dc.publisherSpringer Science and Business Media LLC
dc.rightsOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
dc.subjectAGREE II
dc.subjectClinical practice guidelines
dc.subjectPreterm birth
dc.subject32 Biomedical and Clinical Sciences
dc.subject4204 Midwifery
dc.subject42 Health Sciences
dc.subject3213 Paediatrics
dc.subject3215 Reproductive Medicine
dc.subjectInfant Mortality
dc.subjectHealth Services
dc.subjectClinical Research
dc.subjectPreterm, Low Birth Weight and Health of the Newborn
dc.subjectPerinatal Period - Conditions Originating in Perinatal Period
dc.subject8.1 Organisation and delivery of services
dc.subject8 Health and social care services research
dc.subjectReproductive health and childbirth
dc.subject3 Good Health and Well Being
dc.subject1110 Nursing
dc.subject1114 Paediatrics and Reproductive Medicine
dc.subject1117 Public Health and Health Services
dc.subjectObstetrics & Reproductive Medicine
dc.subject3215 Reproductive medicine
dc.subject4204 Midwifery
dc.subject.meshInfant, Newborn
dc.subject.meshMaori People
dc.subject.meshNew Zealand
dc.subject.meshPremature Birth
dc.subject.meshPrenatal Care
dc.subject.meshPractice Guidelines as Topic
dc.subject.meshHealth Equity
dc.subject.meshInfant, Newborn
dc.subject.meshPremature Birth
dc.subject.meshNew Zealand
dc.subject.meshMaori People
dc.subject.meshPrenatal Care
dc.titleAn Evaluation of the Quality, Suitability and Impact on Equity of Clinical Practice Guidelines Relevant to Preterm Birth for Use in Aotearoa New Zealand
dc.typeJournal Article
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