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Table 3 Barriers identified in focus group and ratings from consensus meeting

From: Determinants of implementation of maternal health guidelines in Kosovo: mixed methods study

Barriers Mean rating Standard deviation Range
Lack of access to medications (e.g., oxytocin). 9.00 0 (9 – 9)
Lack of integration of healthcare resources (e.g., medications, equipment, healthcare personnel) across the system. 8.95 0.05 (8 – 9)
Lack of healthcare/clinical data (e.g., for medication use, hospital diagnoses, complications). 8.81 0.15 (8 – 9)
Lack of ability to monitor implementation of guidelines. 8.76 0.18 (8 – 9)
Lack of ability to document and monitor current practice. 8.66 0.32 (7 – 9)
Lack of communication between professional associations and the Ministry of Health around guideline development. 8.63 0.23 (7 – 9)
Lack of integration of clinical care across the system. 8.60 0.34 (7 – 9)
Lack of accountability for guideline implementation. 8.57 0.35 (7 – 9)
Lack of communication between professional associations and the Ministry of Health around guideline dissemination and implementation. 8.43 0.35 (7 – 9)
Lack of agreement between professional associations and the Ministry of Health around data required for monitoring guideline implementation. 8.37 0.63 (6 – 9)
Lack of agreement with recommendations from guidelines. 8.32 2.42 (2 – 9)
Lack of communication across healthcare provider groups (e.g., physicians, nurses, midwives). 8.26 2.89 (2 – 9)
Lack of process for identifying local opinion leaders/champions. 8.19 0.63 (7 – 9)
Lack of continuing education/continuing professional development on guideline use and implementation (capacity building). 8.10 0.89 (5 – 9)
Lack of a process for prioritising guidelines and recommendations for implementation. 8.09 0.56 (7 – 9)
Lack of undergraduate training (for medical and midwifery students) on guideline use and implementation. 7.85 0.93 (6 – 9)
Lack of clarity about who is responsible for implementing guidelines (e.g., Ministry of Health and/or professional associations). 7.84 2.17 (5 – 9)
Lack of awareness of the protocols/recommendations from the guidelines. 7.70 5.31 (1 – 9)
Lack of awareness of the significance of the clinical problem. 7.21 3.43 (2 – 9)
  1. Response scale: 1 = extremely unimportant; 5 = neither unimportant or important; 9 = extremely important.