Understanding Individual Change in Practice: A Grounded Theory Study of Maternity Care Providers
Open AccessEvidence-based practice is the standard of care in medicine today. In the maternity field, a number of current practices are not based in the evidence while many of those that are supported by evidence remain underutilized. Studies investigating efforts to incorporate evidence into practice across disciplines reveal that, at the group and organizational level, many initiatives are unsuccessful. This is also true in maternity care. Research into provider behavior change at the level of the individual has been sparse in all medical fields. This study sought to explore the experiences of individual maternity care providers (midwives and physicians) who had changed practice from one less based in the evidence, to one with more scientific support. For the purposes of having the providers share a common phenomenon, the change from early cord clamping to delayed cord clamping was chosen.The research was conducted using a constructivist, grounded theory methodology. Seventeen providers were interviewed throughout the United States. This included 5 physicians and 12 midwives.Five major themes and three domains of influence were identified in the analysis of the data. The themes that emerged were 1) trusting colleagues, 2) believing the evidence 3) honoring mothers and families, 4) knowing personal certainty and 5) protecting the integrity of the mother and the baby. The themes served as `drivers of change' for the providers in what emerged as an evolution toward change rather than a decision to change. Three domains of influence developed from the background of the stories of change. These were the personal, professional and institutional domains which contained situations, discourses, and other forces affecting the flow of the change experience.From the findings, the Evolution to Provider Change Model was developed. The model contains three phases: 1) moving toward change, 2) integrating change, and 3) identifying with change. This study provides new understanding about how individual maternity care providers change practices and offers an important perspective on the choice to practice DCC, a beneficial and evidence-based practice for newborns.
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