Factors and strategies influencing implementation of an intravenous iron intervention for antenatal anaemia: A mixed‐methods systematic review

Abstract

Abstract Introduction Anaemia during pregnancy is a significant global health problem, disproportionately affecting women in low‐ and middle‐income countries (LMICs). Oral iron is the standard of care; however, challenges exist regarding adherence and coverage. Increasingly, evidence demonstrates the superiority of intravenous (IV) iron over oral iron. Although clinical experience on IV iron for antenatal anaemia is growing, there remains little understanding regarding implementation. Our mixed‐method systematic review aims to identify barriers and facilitators to implementing an IV iron intervention for pregnant women with anaemia and implementation strategies. Methods Five bibliographic databases and grey literature were searched for studies. Barriers and facilitators were identified and mapped to the Consolidated Framework for Implementation Research (CFIR) and then matched to Expert Recommendations for Implementing Change (ERIC) strategies using the CFIR‐ERIC matching tool. Results The search identified six studies. Most studies captured the perspective of healthcare providers, with some studies capturing the perspective of pregnant women. Barriers and facilitators were mapped to the following CFIR constructs: (1) intervention characteristics—cost, complexity, evidence strength and quality, and relative advantage; (2) outer setting—patient needs and resources; (3) inner setting—culture, available resources and access to knowledge and information; (4) characteristics of individuals—knowledge and beliefs about the intervention; (5) process—champions. Matching ERIC strategies included identifying and preparing champions, conducting educational meetings and assessing for readiness and identifying barriers and facilitators. Conclusion Once tailored to each context, our findings can be used to improve the adoption, implementation, and sustainability of an IV iron programme for pregnant women with anaemia.

Keywords

• maternal health
• maternal medicine
• neonatal outcomes
• nutrition
• pregnancy