Open Access Research article

“One of those areas that people avoid” a qualitative study of implementation in miscarriage management

Blair G Darney1*, Marcia R Weaver23, Deborah VanDerhei4, Nancy G Stevens4 and Sarah W Prager25

Author Affiliations

1 Departments of Medical Informatics and Clinical Epidemiology and Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mailcode L-466, Portland, OR, 97239, USA

2 Department of Health Services, University of Washington, Seattle, WA, USA

3 Global Health, University of Washington, Seattle, WA, USA

4 Department of Family Medicine, University of Washington, Seattle, WA, USA

5 Department Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

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BMC Health Services Research 2013, 13:123  doi:10.1186/1472-6963-13-123

Published: 3 April 2013



Miscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration (MVA) is safe, effective, and saves time and money. Family Medicine residents are not routinely trained to manage miscarriages using MVA, but have the potential to increase access to this procedure. This process evaluation sought to identify barriers and facilitators to implementation of office-based MVA for miscarriage in Family Medicine residency sites in Washington State.


The Residency Training Initiative in Miscarriage Management (RTI-MM) is a theory-based, multidimensional practice change initiative. We used qualitative methods to identify barriers and facilitators to successful implementation of the RTI-MM.


Thirty-six RTI-MM participants completed an interview. We found that the common major barriers to implementation were low volume and a perception of miscarriage as emotional and/or like abortion, while the inclusion of support staff in training and effective champions facilitated successful implementation of MVA services.


Perceived characteristics of the innovation that may conflict with cultural fit must be explicitly addressed in dissemination strategies and support staff should be included in practice change initiatives. Questions remain about how to best support champions and influence perceptions of the innovation. Our study findings contribute programmatically (to improve the RTI-MM), and to broader theoretical knowledge about practice change and implementation in health service delivery.

Miscarriage; Reproductive health services; Family medicine; Practice change; Interprofessional training; Dissemination; Process evaluation