Table 1 Overview of papers included in the review

Duffy et al. (2009)

To assess attitudes of health professionals, explore perspectives, knowledge and experiences of donors, and analyse quality and risk of collection methods of umbilical cord blood for donation purposes.

To examine pre and post-test responses following introduction of the Kingscord cord blood training.

England

Acute teaching hospital with maternity and cord blood collection and donation service

Midwives

Target = 150

Pre-test = 59

(40 % response rate)

Post-test = 47 (31 % RR total; 79.7 % pretest)

Quantitative

Survey: Pre and post education

Findings reported from midwifery participants only.

Overall: Enthusiasm for cord blood collection;

Concerns regarding staffing as a potential problem.

Posttest: useful education with improved knowledge of conditions that could benefit from public CB bank

Pretest:

Knowledge

*All participants aware of CB use for haematological disorders.

*66 % (n = 39) aware additional uses: autoimmune, genetic and degenerative diseases/conditions.

*44 % (n = 26) wanted more information.

*Of 23 who had CB collection experience (39 %), 14/23 (86 %) had performed cord blood collection without prior training.

Attitudes

*Positive responses to program good to fantastic (55, 93 %)

*4 (6.7 %) midwives expressed concerns regarding extra paperwork associated with cord blood donation/collection.

*Posttest:

Knowledge

*Training sessions useful in understanding whole process (29, 62 %) rationale to collect (9, 19 %) and some practical details (9,19 %).

Attitude

*94 % (n = 44) indicated training was very useful; answered all questions

*66 % (n = 31) stated collection training provided all necessary information.

*Participants stated they learned more about cord blood treatable conditions.

*19.1 % suggested the introduction of support in practice.

Small sample size with low response rate for target population (40 % pretest, 31 % posttest)

Survey items and composition not discussed in detail and posttest did not appear to replicate pretest.

Nil validity or reliability testing

reported

Unable to determine if primary aim of assessing attitudes of HP was achieved.

Salvaterra et al. (2010)

To analyze knowledge, comprehension, opinions, attitudes and choices related to cord blood donation of pregnant women, future parents, donors, midwives, obstetricians/gynaecologists.

To compare preferences of public versus private banking.

Italy

Hospital, community & academic sector participation

Antenatal health care providers (n = 32):

Community midwives (n = 10)

Hospital midwives (n = 10)

Obstetricians (n = 10)

Pregnant women, future parents and donors (n = 30)

Mixed methods using participatory approach with establishment of a taskforce and public multidisciplinary round table

Focus groups; (maximum 10 participants, led by 2 psychologists)

Survey: Anonymous self -administered

(Demographic, knowledge, opinion items)

Findings reported from midwives and obstetrician/gynaecologists only.

Overall: Support for altruistic cord blood donation; Better health professional education needed.

Focus Group Themes:

*Hospital & community midwives recognised social/moral value of CB donation Vs no social/moral value recognition by obstetricians

*100 % hospital midwives expressed a negative moral assessment of private cord blood banking

*Midwives viewed obstetricians as providing crucial role in providing parents with information

*All disciplines agreed obstetricians can promote CB donation through providing accurate information to expectant parents.

*Specific education and HP support roles needed to promote donation

Questionnaire

*Obstetricians (30, 94 %) & midwives (28, 87.5 %) were preferred providers of information to parents

*Information should be provided in prenatal courses (24, 75 %)

*Altruistic (25, 78 %) and moral duty (7,22 %) were factors in supporting public donation

Outcome: Development of information brochure

Few knowledge questions; most opinion based.

Small sample sizes allowed for limited between group comparisons

Researchers developed own assessment tool, nil validity or reliability testing reported

Tada et al. (2011)

To understand how obstetricians involved in cord blood collection view and think about this collection process.

Japan

Four Public Cord Blood Banks in two metropolitan areas.

Hospital representative obstetricians who were involved in cord blood collection activities.

Questionnaire (n = 38)

Semi-structured interviews

(n = 8)

Qualitative/Mixed methods

Survey: Self-administered

Semi-structured interviews

Overall: Obstetricians generally willing to participate in cord blood collection.

Status of CB collection

* 60.5 % indicated there was no CB collection training course at their institution.

* 28.9 % believed that CB collection training is necessary prior to collecting CB.

68.4 % believed that CB collection in addition to their routine care did not place a burden on them.

* 84.2 % believed that CB collection did not pose a risk prior to or following delivery.

Training courses

* 6 respondents answered that if CB is simply collected, a training course is not mandatory. However, a training course prior to collecting CB would assist to collect greater volumes and prevent bacterial contamination.

Burden and risks associated with CB collection

*All respondents agreed that there were no risks or burdens as CB collection is stopped if anything goes wrong at the time.

Small sample of a large number of obstetricians in the 53 hospital settings.

Results represent obstetricians’ beliefs and opinions, not knowledge.

Assessment tool adapted from tools used in previous cord blood stem cell quality studies.

Ethical approval not disclosed.

Machin et al. (2012)

To explore the perceptions of key stakeholders (professional and lay) in cord blood banking relating to the role of midwives and privately employed phlebotomists.

England

Hospital, community, CB banking, academic and government sector participation

Purposive sample of stakeholders in UCB Banking

(total n = 69)

Midwives (n = 15)

Obstetricians (n = 8)

Neonatologists (n = 2)

CB Banks (n = 12)

Phlebotomists/donor coordinators (n = 3)

Policy and Government representatives (n = 4)

Royal Colleges (n = 2)

Activist, genetic interest and professional groups (n = 9)

Scientists (n = 4)

CB bank clients (parents) (n = 10)

Qualitative

Semi-structured interviews

(n = 61)

including

Midwives (n = 7);

Obstetricians/neonatologists (n = 10);

Other (n = 44)

Focus Group: 8 midwives

Overall: 3 key themes identified as Negotiating space; Negotiating access and Negotiating priorities and practices.

Acknowledgement of midwives as gatekeepers in access to umbilical cord blood: themes of power, authority and control.

Results highlighted:

*Midwives were perceived as regarding privately employed phlebotomists/CB collectors as external to woman’s care team

*Perception that midwifery practice is prioritised over request for cord blood collection as it benefits maternal and infant health and wellbeing, while CB collection seen as a non-essential ‘option’ or ‘wish’ than can alter ‘important’ midwifery practice.

*Perception that Midwives rank CB collection for private banking as a low priority.

*In contrast, Perception of pregnant women that midwives are in a less powerful role than pregnant women relating to UCB collection (i.e. women’s wishes are the priority), supported by midwifery responses.

Member checking in interpretation of qualitative data was not reported; limits content validity relating to interpretation of midwifery roles and priorities.

Walker et al. (2012)

To measure obstetricians’ levels of awareness and understanding of CB donation and CB therapy;

To measure obstetricians motivation to support CB donation and collection;

To determine frequency of discussion of CB banking options with patients.

United States

57 Metropolitan hospitals affiliated with a public CB bank

Obstetricians (target n = 2041)

Total (n = 295), 14 % response rate

Obstetricians with

privileges at affiliated hospitals (n = 139)

Obstetricians without privileges at hospitals affiliated with public cord blood banks

(n = 156)

Quantitative

Survey:

Multi-choice question, 1 open ended question

Overall: Obstetricians are generally familiar with cord blood transplantation though indicated a desire for more information to effectively inform patients. Similar findings between obstetricians affiliated with a CB donation hospital versus a nonaffiliated hospital.

Understanding of CB Therapy

*88 % of affiliated and 82 % of non-affiliated obstetricians (n = 122/128) reported being familiar or very familiar with cord blood transplant use.

Source of information

*87 % of affiliated and 84 % of non-affiliated obstetricians (n = 121/131) indicated private CB banks as their main source of information

Awareness of CB donation

*98 % of affiliated and 96 % of non-affiliated obstetricians (n = 136/150) knew that private CB banks charge collection and storage fees.

*86 % of affiliated and 69 % of non-affiliated obstetricians (n = 119/108) knew that there were no associated fees for women to donate CB.

Willingness to discuss CB donation with patients

*80 % of affiliated and 70 % of non-affiliated obstetricians (n = 111/109) were confident discussing CB banking options with patients.

*49 % (68/139) of affiliated and 51 % (79/156) of non-affiliated obstetricians felt they had insufficient knowledge of CB donation to effectively answer patient questions.

Willingness to collect CB and perceived barriers to CB collection

*36 % of affiliated and 35 % of non-affiliated obstetricians (n = 50/55) agreed that lack of compensation for doctors is a barrier to public CB collection.

Most common response to patient question regarding what she should do with CB

*37 % of affiliated and 41 % of non-affiliated obstetricians (n = 51/64) stated they discuss all options and benefits and let patient decide.

Survey tool developed and pretested by the National Bone Marrow Program specific for this study.

Separate surveys used for affiliated and non-affiliated participants.

Hatzistilli et al. (2014)

To investigate health care professionals’ knowledge, attitudes and sources of information on UCB donation.

Greece

5 Hospitals: 2 urban (1 with CB bank and transplant centre), 3 rural general hospitals

Midwives

(n = 47)

Obstetricians/Anaesthetists

(n =28)

Nurses

(n = 29)

Administration nurses

(n = 26)

Response rate = 84 %

(n = 109/130)

Quantitative

Survey:

Yes/no: knowledge level

Self-rating question: information sources.

Internal consistency determined (Cronbach Alpha 0.73)

Overall: The study highlighted low levels of informed HP knowledge (15.6 %) and willingness to participate in well organized continuous education for specialists (89 %).

CB donation knowledge

*15.6 % reported as well informed on collection, storage and use of UCB

*Correct responses mean 55.2 % (SD ± 18.5); median 57 % (IQ 25)

*93.5 % declared little or no specific UCB education in last 5 years

*Obstetricians had significantly greater knowledge levels (62.6 %) compared to midwives (59 %) and other health professionals (p < 0.002)relating to cord blood collection, donation, private storage, quality and therapies.

Sources of information:

*Promotional brochures (33 %),

* private CB banks information(22 %), *magazines and newspapers (19.2 %), *bachelor/master academic levels and scientific brochures (18.4 %),

*seminar and conferences (13.7 %)

*National Organisation of Transplantations (EOM) Website (11 %)

Small sample size, limiting generalisability.

1 participating hospital had a cord blood bank.

Researchers developed own questionnaire (internal consistency measured)

Roh et al. (2014)

To investigate obstetricians understanding of CB – collection, legal regulations, limitations and potency of CB banks, and current therapeutic uses - and their role in informing donors and cord blood collection management.

Investigate the quantity of cord blood information provided to patients by obstetricians.

Korea

CB collection centres associated with public CB banks

Obstetricians (n = 57)

Representing CB collection centres (n = 32) with cord blood collection experience.

Quantitative

Survey:

Multi-choice: self-rating knowledge assessment.

Overall: Obstetricians comprehensive understanding of CB banking, collection, transportation, storage, regulations, therapeutic uses and limitations, and potency of public cord blood banking were lower than expected.

CB collection experience and management

*82.5 % had a minimum of 4 years collection experience.

*40.4 % were aware that CB collection was regulated by law.

*21 % felt that CB collection distracted the labour process.

*15.8 % were concerned about delayed bleeding control during CB collection especially during LSCS delivery.

Knowledge about CB current uses

*82.7 % correctly rated the therapeutic uses of cord blood.

*54 % self-rated their knowledge level about cord blood usefulness as average. 30 % self-rated their knowledge as below average.

Response to patient requests made for information on difference between public and private CB banks

*5.3 % did not provide any information.

*61.4 % provided contact information for public and private banks.

*33.3 % verbally informed women of the differences between the banks. (100 % of this group showed the highest rate of CB processing post collection.)

A small sample of a large number of cord blood collection centres so results may not be generalised to the population.

Survey tool adapted from Walker et al. (2012) study.

Mohammed & El Sayed (2015)

To evaluate the effectiveness of educational program on maternity nurses’ knowledge and attitude regarding cord blood collection and stem cells.

Egypt

2 hospital settings: labour unit, University hospital and maternity University hospital

All maternity nurses employed in the 2 settings at time of study were included.

Total (n = 53)

Obstetric department

(n = 28)

Maternity hospital

(n = 25)

Pilot with content validity by expert panel,

Reliability testing Cronbach’s Alpha for Knowledge =0.92, Attitude 0.87.

Survey: Pre and post education: closed and open-ended questions.

Part 1: Knowledge and Demographics.

.Part 2: Attitudes: Likert Scale,

Pretest survey results informed education intervention

Post-test survey: 1)immediately post education 2) 3 month post education

Overall: Maternity nurses’ knowledge and attitudes towards CB collection and stem cells improved following education intervention.

Knowledge

*Pre-education: 88.7 % had poor knowledge levels of cord blood collection and stem cells.

*Post education: 90.6 % had good knowledge levels of cord blood collection and stem cells immediately post education; 81.2 % good knowledge at 3 months post education.

Attitudes

*Pre-education: 98.1 % of had a negative attitude towards cord blood collection and stem cells.

*Post education: 66 % had a positive attitude to cord blood collection.

Educational session duration not consistent due to workload management.

Educational intervention developed specific to participant areas and processes, limited use in other countries dependent on content.

Moustafa & Youness (2015)

To assess maternity nurses knowledge of cord blood banking and to identify barriers of it to be applied.

Egypt

Large Obstetrics & Gynaecology Department in University Hospital

Convenience sample of maternity nurses employed in antenatal, labour, postnatal wards and antenatal clinic (n = 150).

Quantitative

Survey: Descriptive Design of demographics and knowledge

Content Face validity established through use of expert panel and pilot.

Overall: Knowledge about CB banking was reported as inadequate. Barriers to CB banking were identified as cost of CB banking, policies and procedures of conducting new technology at the hospital.

Main Source of information

*Books & magazines (39.3 %), seminars & conferences (14 %).

Level of knowledge

*78.7 % of nurses reported as having inadequate knowledge of cord blood banking.

*58 % reported they did not know the advantages of CB banking & 34 % did not know the disadvantages of CB banking.

*14 % did not know CB collection procedures.

*95.3 % wanted further information through training and education programs

*More experienced and qualified nurses were more likely to have adequate knowledge scores

Barriers to providing CB banking

*70 % believed cost of CB banks, followed by policies & procedures of hospital (66 %), time taken to educate women (54 %), lack of nurses knowledge & cultural beliefs (both 52 %), pregnancy not being suitable time to make decisions (38 %), lack of women’s knowledge (34 %), religious barriers (32.6 %).

Sample from one hospital, results potentially not generalisable across settings and other countries. Response rate not reported.

Tool reported to have confirmed validity through use in other studies; no references provided for these other studies.