Reflecting on the evidence-practice gap - a participatory approach in use of CTG in midwifery practice.

INTRODUCTION: Midwives and obstetricians often overuse Cardiotocography (CTG) when monitoring low-risk births, despite evidence and guidelines recommending intermittent auscultation (IA). This study aims to examine whether and how a participatory intervention can provide initiatives that enhance midwives' use of evidence-based CTG monitoring in low-risk births. METHODS: Midwives and obstetricians from Viborg Regional Hospital participated in workshops at the hospital. Participatory design was applied using the "User Innovation Management" framework to guide two workshops with midwives and obstetricians. In Workshop 1, the participants explored needs, motives, and visions related to fetal monitoring. In Workshop 2, they developed specific initiatives for evidence-based practice. Data from the workshops was collected through audio recordings and written notes and analysed using manifest content analysis. RESULTS: Through collaborative workshops, participants co-developed three overarching initiatives aimed at the midwives: (1) Creating a culture of psychological safety and knowledge sharing, (2) Fostering recognition and mentoring, (3) Implementing practical changes. These initiatives were supported by 14 proposed actions, including training days for educational staff, improved communication materials, and structural adjustments to daily routines. These initiatives reflect a strong desire among clinicians to create a psychologically safe working environment, enhance professional recognition, and implement practical changes aligned with clinical guidelines and evidence-based practice. CONCLUSION: Engaging clinicians through participatory methodologies facilitated the co-development of initiatives that are both actionable and contextually appropriate. This collaborative approach may enhance midwives' information to couples, thereby aligning the use of CTG monitoring in low-risk births with current evidence-based guidelines.