Evidence map›Paper›PMID 41387855›Full record

ArticleBMC health services research2025

Understanding enablers and barriers to implementing the Safer Baby Bundle: a mixed-methods study with site leads.

Christine Andrews, Fran Boyle, Ashley Pade, Ann Lancaster, Philippa Middleton, David Ellwood, Adrienne Gordon, Michael Nicholl, Kirstine Sketcher-Baker, Tanya Farrell and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Christine AndrewsCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia. christine.andrews@mater.uq.edu.au.
Fran BoyleCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Ashley PadeCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Ann LancasterCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Philippa MiddletonCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
David EllwoodCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Adrienne GordonCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Michael NichollThe University of Sydney, School of Medicine, Sydney, Australia.
Kirstine Sketcher-BakerClinical Excellence Queensland, Brisbane, Australia.
Tanya FarrellSafer Care Victoria, Melbourne, Victoria, Australia.
Ida Stevia DigetCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
Vicki FlenadyCentre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Australian Safer Baby Bundle (SBB) consists of five elements (smoking cessation, fetal growth restriction, decreased fetal movements, maternal side sleeping and decision making around timing of birth) which aim to reduce stillbirth and improve antenatal care. Queensland (QLD), New South Wales (NSW), and Victoria (VIC) were the first states to implement the SBB, laying the foundation for its national rollout. This study explores site leads’ experiences integrating the SBB into routine care.

methodsA mixed-methods study was conducted using surveys and interviews with site leads following SBB implementation across maternity services in QLD, NSW and VIC. Quantitative data were analysed descriptively, qualitative data underwent inductive and deductive thematic analysis, guided by Normalisation Process Theory (NPT) to identify implementation barriers and enablers.

resultsIn 2022, 45 site leads completed surveys, and 20 were interviewed. From surveys, most reported strong endorsement of the SBB from hospital leadership (81%) and opinion leaders (73%). However, only 32% felt their service was adequately resourced, and just 17% believed teams had enough time for Quality Improvement (QI) activities. Only two of five SBB elements, decreased fetal movements (93%) and maternal side sleeping (82%), were reliably implemented across sites. Other elements showed moderate uptake, with smoking cessation (47%) achieving the lowest fidelity. From interviews, five themes were identified as barriers and enablers to implementing and sustaining the SBB in routine practice: (1) nationally consistent resources and training; (2) navigating QI readiness and capacity; (3) collaborative change; (4) service capacity to make recommendations operational; and (5) capability to access data and track progress. Mapping to the four NPT constructs revealed key drivers of SBB implementation: coherence (understanding the approach), cognitive participation (engagement), collective action (operationalising change through relationships) and reflexive monitoring (assessing and adapting).

conclusionsSBB implementation was supported by strong leadership endorsement but challenged by limited resources, time for QI, and the exacerbating effects of the COVID-19 pandemic. Reliable integration of key elements varied across sites, shaped by consistent training, service capacity, collaborative approaches, and access to data. These findings underscore the need for tailored support and resilient infrastructure to embed and sustain evidence-based antenatal care practices at scale.

trial registrationThe Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.

Indexed as

Patient Care BundlesPrenatal CareAustraliaFemaleFetal MovementHumansInterviews as TopicNew South WalesPregnancyQualitative ResearchQuality ImprovementSmoking CessationStillbirthSurveys and QuestionnairesCare bundleComplex interventionImplementationNormalisation process theoryQualitative studyStillbirthStillbirth prevention

Identifiers

PMID41387855
PMCPMC12817641

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.