A study on the Partnership Programme of a Public Umbilical Cord Blood Bank in the Kingdom of Saudi Arabia: A Critical Realist Approach

Abstract

Background: Umbilical cord blood (UCB) is a rich source of stem cells for a wide range of malignant and non-malignant diseases. Many countries have a public banking system where donors’ UCB can be stored and used within the public health system. Aim: This study aimed to identify the reasons for a decline in the UCB collection rate at a public UCBB programme in the Kingdom of Saudi Arabia. The barriers inhibiting the UCB collection programme, and the facilitators aiding it were investigated. The UCB programme relied on midwives’ voluntary and parent participation and this study focused on these relationships and their impact. Methodology: A critical realism (CR) study was conducted to understand the cause of the decline in UCB collection and donation rates. Thirty-seven semi-structured interviews were conducted with UCB nurses, policymakers, midwives, antenatal nurses, obstetricians and mothers. Field notes and documentary review were also used as part of data collection. Data were analysed using critical realist analysis. Results: Three barriers were distilled from the critical realist analysis. Firstly, the lack of clear leadership and supervision led to confusion regarding different policies, logistical problems, and a lack of motivation to participate. Secondly, the current UCB nurses lacked the necessary soft skills and broader nursing experience to establish a strong working relationship with the primary hospital maternity department’s midwives in order to handle the parents’ needs. Finally, the parents’ lack of understanding about the programme, combined with their educational background, allowed superstitions and other cultural practices to discourage them from donating. This was worsened by poorly timed consent-seeking procedures. UCB nurses were also poorly trained in the UCB programme. These barriers interacted closely with each other and resulted in the systemic failure of the UCB programme whilst the altruistic nature of UCB donation aligned well with Islamic values and served as a facilitator. Conclusion and recommendations: A decline in the rate of UCB collection and donation is a result of the complex interplay of the three barriers mentioned above within the UCB programme. The roles of the midwives and UCB nurses should be reconsidered, appropriate training and incentives need to be in place, and these must be cemented within the policy documentation.