{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:35:22Z","timestamp":1786714522286,"version":"build-2736575974"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Over the past 2 decades, rural Northern Ontario has experienced widespread closure of obstetric care services, leaving only 9 sites operational. As a result, many pregnant persons in the region now face substantial travel times to access care, increasing the risk of adverse maternal and fetal outcomes. Understanding how the remaining obstetric programmes continue to operate within the same healthcare environment that has contributed to closures elsewhere in rural Northern Ontario offers insight into factors enabling programme sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A qualitative study design was used. Semi-structured interviews were conducted with physicians, nurses and administrators from the 9 rural Northern Ontario hospitals that continue to provide obstetrics. Interview guides were informed by previous research on rural obstetric closures and designed to explore the factors participants considered important to programme sustainability. Interviews were analysed using Braun and Clarke\u2019s thematic analysis framework to identify the supports, approaches and practices perceived to enable programme continuity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-three participants were interviewed. Analysis revealed 4 overarching themes participants perceived as important for supporting the continuity of rural obstetrics: (1) passion and commitment, (2) workforce capacity and sustainability, (3) collaborative systems and support and (4) adaptive and safe practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Sustainability factors identified in rural Northern Ontario\u2019s remaining obstetric programmes appear to address challenges linked to programme closures elsewhere, including workforce shortages, declining provider competence and limited structural support. Integrating these sustainability factors into programme design may strengthen current services, reduce risks of closure and guide re-establishment of obstetric care in communities where it has been lost.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Au cours des deux derni\u00e8res d\u00e9cennies, le Nord rural de l\u2019Ontario a connu de nombreuses fermetures de services obst\u00e9tricaux, au point o\u00f9 seulement neuf sites demeurent en activit\u00e9. Par cons\u00e9quent, plusieurs personnes enceintes de la r\u00e9gion doivent maintenant parcourir de longues distances pour acc\u00e9der aux soins, ce qui augmente le risque d\u2019issues d\u00e9favorables pour la m\u00e8re et le f\u0153tus. Comprendre comment les programmes obst\u00e9tricaux encore en place r\u00e9ussissent \u00e0 fonctionner dans le m\u00eame environnement de soins qui a men\u00e9 \u00e0 des fermetures ailleurs dans le Nord rural de l\u2019Ontario permet de mieux cerner les facteurs qui favorisent leur p\u00e9rennit\u00e9.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>M\u00e9thodes:<\/jats:title>\n                    <jats:p>Une \u00e9tude qualitative a \u00e9t\u00e9 r\u00e9alis\u00e9e. Des entrevues semi-dirig\u00e9es ont \u00e9t\u00e9 men\u00e9es aupr\u00e8s de m\u00e9decins, d\u2019infirmi\u00e8res et d\u2019administrateurs provenant des neuf h\u00f4pitaux ruraux du Nord de l\u2019Ontario qui offrent encore des soins obst\u00e9tricaux. Les guides d\u2019entrevue s\u2019appuyaient sur des recherches ant\u00e9rieures portant sur les fermetures de services obst\u00e9tricaux en milieu rural et visaient \u00e0 explorer les facteurs que les participants jugeaient importants pour assurer la p\u00e9rennit\u00e9 des programmes. Les entrevues ont \u00e9t\u00e9 analys\u00e9es selon le cadre d\u2019analyse th\u00e9matique de Braun et Clarke afin de d\u00e9gager les formes de soutien, les approches et les pratiques per\u00e7ues comme favorisant la continuit\u00e9 des programmes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>R\u00e9sultats:<\/jats:title>\n                    <jats:p>Vingt-trois participants ont \u00e9t\u00e9 interview\u00e9s. L\u2019analyse a fait ressortir quatre grands th\u00e8mes jug\u00e9s importants pour soutenir la continuit\u00e9 des soins obst\u00e9tricaux en milieu rural: (1) la passion et l\u2019engagement; (2) la capacit\u00e9 et la p\u00e9rennit\u00e9 de la main-d\u2019\u0153uvre; (3) les syst\u00e8mes collaboratifs et le soutien; et (4) des pratiques adaptatives et s\u00e9curitaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Les facteurs de p\u00e9rennit\u00e9 recens\u00e9s dans les programmes obst\u00e9tricaux encore en place dans le Nord rural de l\u2019Ontario semblent r\u00e9pondre \u00e0 des d\u00e9fis associ\u00e9s aux fermetures survenues ailleurs, notamment les p\u00e9nuries de main-d\u2019\u0153uvre, l\u2019\u00e9rosion des comp\u00e9tences des fournisseurs de soins et le manque de soutien structurel. L\u2019int\u00e9gration de ces facteurs dans la conception des programmes pourrait renforcer les services actuels, r\u00e9duire les risques de fermeture et guider le r\u00e9tablissement des soins obst\u00e9tricaux dans les communaut\u00e9s o\u00f9 ils ont \u00e9t\u00e9 perdus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/cjrm.cjrm_79_25","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T12:00:46Z","timestamp":1786104046000},"page":"113-121","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Locally delivered: Identifying factors sustaining rural Northern Ontario\u2019s remaining obstetric programmes \u2013 A qualitative study"],"prefix":"10.4103","volume":"31","author":[{"given":"Sarah C. 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