Multilevel determinants of prenatal syphilis screening policy implementation

PROJECT SUMMARY/ABSTRACT This R03 proposal aims to explore the multilevel determinants of the implementation of prenatal syphilis screening policies into clinical practice among obstetric providers. Professional organizations have endorsed evidence-based guidelines (“guidelines”) to screen for syphilis at prenatal visits and reduce the burden of these

infections, but states can also regulate their own screening requirements through legislation and policies (“policies”). The guidelines and policies are inconsistent and differ widely in their scope, populations of focus, recommended timing of screening, and determinants of risk (ACOG, 2017; Curry et al., 2018; Workowski et al.,

2021). To identify leverage points and enact systems-level change, exploring the multi-level factors influencing implementation of these prenatal syphilis guidelines and policies into obstetric care is essential. The long-term goal is to increase rates of syphilis screening at prenatal visits, thus reducing the rates of congenital syphilis in

Texas. The objective is to identify implementation strategies for obstetric providers to facilitate the prenatal syphilis screening policies into clinical care. This study will align with the steps of Implementation Mapping, and we will form a Planning Board (n=10) comprised of obstetric providers across various practice settings

(physicians, nurse practitioners, nurse midwives, registered nurses), hospital management, clinic administrators, and prenatal patients. The Planning Board will participate in all study aims (Fernandez, 2019). Aim 1: Assess the multilevel determinants of prenatal syphilis screening policy implementation. Guided by the

Consolidated Framework for Implementation Research (Damschroder et al., 2009), in-depth interviews will be conducted with obstetric providers, hospital/clinic administrators, and prenatal patients in Texas (n=45; Task 1 of Implementation Mapping). The multilevel determinants, barriers, and facilitators to implementation of syphilis

screening policies into clinical care will be assessed. Aim 2. Develop a multilevel prenatal syphilis screening policy implementation strategy. Using a modified Delphi approach, the Planning Board will develop a logic model of change, expected outcomes, performance objectives, and matrices of change (Task 2 of

Implementation Mapping). The Planning Board will choose theory and/or evidence-based methods to influence the identified determinants and subsequently select implementation strategies to operationalize those methods based on Powell's compilation of implementation strategies (Task 3 of Implementation Mapping). This project will

enhance knowledge of contextual and systems-level determinants influencing obstetric providers practice behaviors and hospital management decision-making. It will also provide information on implementation of syphilis policies in Texas - the state with the highest congenital syphilis rates in the country. Upon preliminary

development of a multilevel implementation strategy, the research team will submit an implementation science- focused R01 during Year 2 to complete Tasks 4-5 of Implementation Mapping, including experimentally testing the proposed strategy through a hybrid Type II effectiveness-implementation study design.