Table 3.
Association between six barriers to vulnerability assessment and antenatal care organization, GP, and practice characteristics.
| Barrier level | Individual GP barrier | Practice organizational barriers | System-level barriers | ||||
|---|---|---|---|---|---|---|---|
| Outcome variable | TDF domain | Behavioural regulation | Memory and attention | Social influences | Believe in capability | Environmental context and resources | Reinforcement |
| Construct | Lacking routines in how to address vulnerability (D) | GPs and staff lacking shared attention on assessing vulnerability (C) | Insufficient organizational culture—Lacking medical record-keeping (F) | Lacking overview whether managing assessment of vulnerability (H.1) | Perceived sufficiency of socio-political context—remuneration (E.2) (reversed) | Increased motivation from extra remuneration (M) | |
| Explanatory variable | Text | aOR (CI) | aOR (CI) | aOR (CI) | aOR (CI) | aOR (CI) | aOR (CI) |
| Time to 1st ANC consultation in minutesa | <30 | 1.16 (0.70–1.92) | 0.94 (0.56–1.56) | 0.82 (0.53–1.29) | 1.01 (0.60–1.71) | 0.65 (0.38–1.10) | 1.29 (0.75–2.21) |
| 30 | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| >30 | 1.03 (0.77–1.37) | 0.90 (0.68–1.20) | 0.63 (0.47–0.84)** | 1.07 (0.80–1.43) | 1.52 (1.14–2.01)** | 1.08 (0.81–1.42) | |
| Allocating extra time to ANC for vulnerable pregnant women a | Never | 1.43 (0.93–2.21) | 1.78 (1.15–2.74)** | 0.75 (0.48–1.15) | 1.43 (0.93–2.20) | 0.50 (0.32–0.78)** | 0.52 (0.34–0.80)** |
| Rarely | 1.41 (0.98–2.04) | 1.69 (1.18–2.41)** | 1.09 (0.77–1.54) | 1.25 (0.89–1.75) | 0.85 (0.59–1.22) | 0.92 (0.65–1.31) | |
| Sometimes | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| Often | 0.85 (0.57–1.29) | 0.92 (0.62–1.37) | 0.76 (0.52–1.13) | 0.81 (0.53–1.24) | 1.39 (0.95–2.04) | 0.96 (0.68–1.38) | |
| Always | 0.93 (0.52–1.63) | 0.89 (0.52–1.53) | 0.47 (0.27–0.82)** | 0.67 (0.40–1.12) | 1.60 (0.89–2.88) | 0.85 (0.49–1.49) | |
| Delegating ANC consultations fully to practice staffa | No | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) |
| Yes | 0.77 (0.55–1.08) | 0.92 (0.64–1.33) | 0.70 (0.50–0.99)* | 0.74 (0.52–1.05) | 1.17 (0.83–1.65) | 1.10 (0.79–1.54) | |
| GP trainees doing 1st ANC consultationa | Always/often | 0.83 (0.47–1.46) | 0.96 (0.59–1.57) | 0.71 (0.40–1.26) | 0.81 (0.46–1.40) | 1.09 (0.61–1.95) | 0.84 (0.49–1.44) |
| Sometimes | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| Rarely | 1.33 (0.93–1.90) | 0.84 (0.60–1.18) | 0.98 (0.70–1.38) | 1.01 (0.71–1.43) | 1.63 (1.15–2.31)** | 1.53 (1.08–2.18)* | |
| Never | 1.51 (0.69–3.30) | 1.57 (0.67–3.71) | 1.27 (0.59–2.75) | 2.72 (1.20–6.17)* | 2.56 (1.02–6.42)* | 3.57 (1.49–8.56)** | |
| No trainees | 1.29 (0.79–2.11) | 0.90 (0.57–1.43) | 0.96 (0.61–1.49) | 0.90 (0.55–1.49) | 1.25 (0.77–2.02) | 1.14 (0.75–1.73) | |
| Prioritizing continuity in ANC between HCP and pregnant woman a | Never | 1.30 (0.22–7.80) | 1.04 (0.21–5.23) | 0.78 (0.11–5.69) | 0.73 (0.13–4.05) | 0.65 (0.04–11.24) | 2.35 (0.48–11.45) |
| Rarely | 0.96 (0.30–3.06) | 0.58 (0.19–1.73) | 0.91 (0.34–2.44) | 1.19 (0.57–2.51) | 0.70 (0.29–1.69) | 0.50 (0.10–2.43) | |
| Sometimes | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| Often | 0.67 (0.33–1.36) | 0.57 (0.33–0.97)* | 0.72 (0.40–1.30) | 0.93 (0.51–1.69) | 0.70 (0.37–1.31) | 0.84 (0.42–1.68) | |
| Always | 0.35 (0.16–0.75)** | 0.36 (0.19–0.68)** | 0.45 (0.24–0.86)* | 0.47 (0.24–0.91)* | 0.52 (0.26–1.06) | 0.54 (0.25–1.14) | |
| GP gendera | Male | 1.60 (1.22–2.09)*** | 1.30 (1.00–1.68)* | 0.85 (0.65–1.11) | 1.46 (1.11–1.93)** | 0.79 (0.60–1.03) | 1.06 (0.81–1.38) |
| Female | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| GP age in yearsa | ≤45 | 1.56 (1.14–2.12)** | 1.11 (0.83–1.50) | 1.03 (0.76–1.41) | 1.31 (0.94–1.82) | 1.01 (0.74–1.39) | 1.42 (1.02–1.97)* |
| 46–60 | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| >60 | 0.97 (0.66–1.42) | 1.30 (0.86–1.94) | 1.55 (1.08–2.22)* | 1.12 (0.77–1.63) | 1.55 (1.08–2.22)* | 0.76 (0.52–1.10) | |
| Practice typea | Single–handed | 0.68 (0.41–1.13) | 1.00 (0.60–1.67) | 0.92 (0.57–1.48) | 0.80 (0.47–1.35) | 1.33 (0.82–2.16) | 0.94 (0.62–1.43) |
| Partnership | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| Patient load (average number of patients/GP)a | <1500 | 1.21 (0.79–1.85) | 1.15 (0.76–1.75) | 0.81 (0.53–1.23) | 1.14 (0.75–1.74) | 1.25 (0.86–1.83) | 0.98 (0.68–1.41) |
| 1500–2000 | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| >2000 | 1.04 (0.69–1.56) | 0.81 (0.48–1.38) | 0.80 (0.48–1.32) | 0.69 (0.44–1.08) | 0.73 (0.42–1.27) | 0.84 (0.53–1.34) | |
| Region | Capital Region | 0.96 (0.65–1.41) | 0.98 (0.66–1.46) | 0.89 (0.60–1.32) | 0.89 (0.61–1.31) | 0.95 (0.65–1.38) | 1.10 (0.75–1.63) |
| Region Zealand | 0.97 (0.58–1.63) | 1.17 (0.77–1.78) | 0.86 (0.57–1.31) | 0.87 (0.52–1.45) | 1.33 (0.82–2.16) | 0.78 (0.49–1.22) | |
| Region of Southern Denmark | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | 1.00 (1.00–1.00) | |
| Central Denmark Region | 0.95 (0.67–1.34) | 0.80 (0.55–1.16) | 0.75 (0.53–1.06) | 0.86 (0.60–1.22) | 1.19 (0.82–1.73) | 1.09 (0.74–1.60) | |
| Region of Northern Denmark | 0.79 (0.48–1.30) | 0.83 (0.47–1.47) | 0.86 (0.52–1.44) | 0.75 (0.43–1.33) | 1.60 (1.00–2.58) | 0.93 (0.57–1.51) | |
Barriers represented by selected domains of the Theoretical Domain Framework, N = 760.
GP: general practitioner; ANC: Antenatal care.
aAdjusted for ANC organization, GP and practice characteristics.
***P < 0.001, **P < 0.01, *P < 0.05.