An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand: Healthcare managers' perspectives

Abstract

Objective: To identify healthcare managers' perspectives on the barriers to implementing cervical length screening to prevent preterm births. Methods: In Phase I, 10 healthcare managers were interviewed. Phase II comprised questionnaire development and data validation. In Phase III, the questionnaire was administered to 40 participants, and responses were analyzed. Results: Their average related work experience was (21.0±7.2) years; 39 (97.5%) respondents also had healthcare management responsibilities at their respective hospitals. Most hospitals were reported to have enough obstetricians (31 cases, 77.5%) and to be able to accurately perform cervical length measurements (22 cases, 55.0%). However, no funding was allocated to universal cervical length screening (39 cases, 97.5%). Most respondents believed that implementing universal screening, as per Ministry of Public Health policies, would prevent preterm births (28 cases, 70.0%). Moreover, they suggested that hospital fees for cervical length measurements should be waived (34 cases, 85.0%). Three main perceived barriers to universal screening at tertiary hospitals were identified. They were heavy obstetrician workloads (20 cases, 50.0%); inadequate numbers of medical personnel (24 cases, 60.0%); not believing that the screening test could prevent preterm birth (8 cases, 20%) and lack of free drug support for preterm birth prevention in high-risk cases (29 cases, 72.5%). Conclusions: The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy. The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.