Knowledge Translation in Action: An Evaluation of the Implementation of Customised Birthweight Centiles at One New Zealand District Health Board

Abstract

Identifying small for gestational age (SGA) and large for gestational age (LGA) babies is important, because these babies may be at increased risk of hypoglycaemia at birth. It is proposed that customised birthweight centiles (CBWC) can more accurately identify these babies by taking into account several physiological variables of the pregnancy affecting birthweight. These variables are: maternal height and booking weight, ethnicity, parity, the baby's gender and gestation. CBWC for a New Zealand (NZ) population were developed by McCowan, Stewart, Francis and Gardosi (2004), and can be downloaded for free from www.gestation.net. Using CBWC is not in common practice in NZ, even though its use was discussed in a 2007 Health and Disability Commissioner report in relation to neonatal hypoglycaemia. The setting for the study was a NZ District Health Board (DHB) that calculates a CBWC for each birth. The research question asked how the evidence behind CBWC was put into practice and what outcomes resulted from translating this knowledge into action. This was a mixed methods evaluation which included interviews, focus groups, an audit and document analysis. The knowledge-to-action (KTA) framework (Straus, Tetroe, & Graham, 2009) was used as a theoretical template to describe the implementation process that occurred. The results revealed that maternity care providers were initially challenged by the evidence. But over time, guideline compliance improved as practitioners experienced the benefit of using CBWC in practice. All agreed that the CBWC calculator was user-friendly. However, the audit demonstrated it was easy to make a mistake or manipulate results when using the calculator. CBWC can help identify babies at risk of hypoglycaemia who otherwise would have been missed. But it is unknown what difference it had made in improving neonatal morbidity and mortality, due to insufficient data. But anecdotally, stakeholders felt it had made a difference. The findings demonstrated that knowledge translation is a complex process which is difficult to capture within a one-dimensional framework. However, using such a framework can identify what stages are needed to complete an implementation process.