Acceptability and use of clinical decision support tools in maternity settings: Systematic review of qualitative studies

Failure to identify and respond to risks is a major contributor to preventable maternal and perinatal deaths. Clinical decision support tools (CDSTs) are designed to assist healthcare professionals in assessing risk and guiding optimal clinical management. However, there are concerns that these tools may cause cognitive overload without enhancing decision-making. This systematic review aimed to explore factors affecting the acceptability, usability, and effectiveness of CDSTs in maternity settings. Six databases were searched from inception till February 2025. No restrictions were placed on date of publication, geographical location or language. Studies were eligible if they reported qualitative data on the acceptability, usability, or effectiveness of CDSTs in maternity settings. Two reviewers independently carried out study selection and quality assessment using the Critical Appraisal Skills Programme (CASP) tool. Data was analysed by thematic analysis, and themes were refined through team discussion. Sixteen eligible studies were included, involving 1639 women; nine studies (823 women) were conducted in low- and middle-income countries and seven studies (816 women) in high-income countries. CDSTs were deemed acceptable in maternity settings to both healthcare professionals and pregnant women and were thought to support improved decision-making. Facilitators included adequate training, incentives, and transparency. Reported barriers included limited computer literacy, language barriers, and context-specific implementation issues. CDSTs were found to support health care providers in improving the quality of maternity care through timely risk assessment. Facilitators and barriers should be taken into consideration during the design and implementation of CDST to maximise the acceptability, usability and effectiveness of these tools.