Table 6 Examples of using qualitative evidence to populate the evidence-to-decision framework criterion on the feasibility of the intervention

Antenatal care (ANC) guideline – group ANC [11]

Commissioned synthesis (provider findings) [35]

Synthesis finding 1 - Continuity of care (moderate confidence). Providers offering group ANC felt that the model gave them the opportunity to practice continuity of care and this was seen as a facilitator for the delivery of good quality ANC. Where providers were not able to offer continuity of care, this was viewed as a barrier to the delivery of quality ANC

Synthesis finding 2 - Condition of clinic (moderate confidence). Providers in sub-Saharan Africa feel that clinics are in a very poor condition and are not amenable to the delivery of ANC. They cited a lack of running water or electricity, no phone lines and dirty rooms as specific concerns

Evidence from high resource settings suggests that health professionals view the facilitative components of group antenatal care as a skill requiring additional investment in terms of training and provider commitment (moderate confidence in the evidence). Some providers also feel that clinics need to be better equipped to deliver group sessions, i.e. clinics need to have large enough rooms with adequate seating (moderate confidence in the evidence)

ANC guideline – midwife-led continuity of care [11]

Commissioned synthesis (provider findings) [35]

1. Staff shortages (high confidence). Providers felt that their ability to deliver high quality ANC was restricted by a shortage of frontline staff

Qualitative evidence from a variety of resource settings highlights concerns among providers about potential staffing issues, e.g. for the delivery of case-load or one-to-one approaches (high confidence in the evidence)

Intrapartum care guideline – episiotomy [13]

Commissioned synthesis (provider findings) [45]

Synthesis Finding 3 – Some health professionals were reluctant to change their practice of routine episiotomy because of entrenched views based on experience and opinion rather than evidence. Midwives felt powerless to change practice because of patriarchal and hierarchical systems resistant to change

Synthesis Finding 5 – Some health professionals performed episiotomy in certain situations (baby too big, tight perineum, preventing a tear, fetal bradycardia, non-reassuring fetal status, shoulder dystocia) and cited a lack of hospital policy and limited access to current evidence as mitigating factors

Synthesis Finding 6 – In some contexts, health professionals felt that an episiotomy enabled them to ‘manage’ labour and birth. In a clinical sense, they felt an episiotomy limited the potential for tearing and, from a workload perspective, helped to speed up a slow labour and ease bed space pressures

Information from a qualitative systematic review exploring women’s and providers' views of intrapartum care suggest that a practice of selective/restrictive episiotomy would be easier to implement, especially in settings where resources may be limited (high confidence in the evidence). However, in certain contexts, staff may have limited access to current research evidence (because of resource constraints) and subsequently have no clear policies or protocols to guide practice in this area (high confidence in the evidence). As a result, clinical practice is based on established, hierarchical, unwritten ‘rules’ and/or competence in performing the procedure (high confidence in the evidence)