Guidelines on anaemia: Effect on primary-care midwives in The Netherlands

Objective: To assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. Design: Cross-sectional survey study. Setting: Primary-care midwifery in The Netherlands. Participants: 160 Midwives (60% response rate). Measurements: Questionnaire on the knowledge of, and attitudes and self-reported adherence to, 14 key recommendations in the guideline; attitudes to guidelines in general; and perceived barriers to implementation. Findings: The number of midwives agreeing with and adhering to specific recommendations varied between 29 and 90%. Most midwives had a positive attitude to the guidelines. The most relevant general barriers were related to the behaviour of general practitioners and obstetricians (32% of the midwives reported this). Larger numbers of midwives mentioned barriers to specific aspects of the guideline, particularly alternative iron supplementation or dietary supplements (59%), and not prescribing iron supplementation if haemoglobin was low but mean corpuscular volume was normal (49%). Key conclusions: The guideline on anaemia was well received by primary-care midwives in The Netherlands, but implementation of specific recommendations needs further attention. Implications for practice: The study provides evidence for the national organisation of midwives to continue with the development and implementation of clinical guidelines. ?? 2005 Elsevier Ltd. All rights reserved.