Women’s information needs in the childbirth continuum: methodological challenges and findings of a qualitative evidence synthesis in the context of National Antenatal care guidelines development in Italy

Introduction: Qualitative evidence synthesis (QES) is increasingly adopted for the development of clinical guidelines in healthcare. QES in the context of guidelines development offers a unique contribution to understand human perspectives and experiences, but can also foster methodological dilemmas, as debated in the literature.
Goals and Methods: We conducted a systematic review to identify, appraise and synthesise qualitative studies exploring women’s information needs in the childbirth continuum in the context of the development of national guidelines on Antenatal Care. We faced a number of challenges and sought innovative approaches, adopting pragmatic choices in light of limited resources. We adopted a 3-step purposive sampling strategy opting for criteria that could enable maximum variation of perspectives. A thematic analysis was conducted on the data from the final sample. Multiple tools including Nvivo software and Miro platform were utilised to enable an iterative process from coding to final findings of the QES and overcome barriers due to remote collaborative work. The GRADE CERQual approach was used to assess the level of confidence in the QES findings and cautelative approach adopted in case of doubts on any of the four components of the framework.
Results: A total of 30 studies, conducted in 16 different countries, were sampled and analysed for the QES from the initial 45 results of the systematic review. A total of 22 subthemes converged into four main themes related to women’s needs including: 1) information sources; 2) features of information provision, 3) space/time for information and 4) content preference/needs. The overall GRADE CERQual level of confidence for the synthesis findings ranged from moderate to high.
Conclusion: QES enriches guidelines development for better maternity care. Rigorous and pragmatic approaches, combined with creativity can help address methodological challenges related to QES and the use of GRADE CERQual approach in this context.