Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries

Before introducing a new clinical intervention to improve the early detection of postpartum hemorrhage, we used multiple data collection methods (interviews, surveys, observations, and stakeholder workshops) to have a broad and in-depth understanding of key implementation issues, which included staff and drug shortages, limited in-service training, and different attitudes of staff toward adopting a new clinical intervention despite its perceived benefits.

Conducting a pilot study with a process evaluation identified required modifications to implementation strategies before a larger randomized trial.

Delivery of a new clinical care bundle and supporting implementation strategies for earlier postpartum hemorrhage detection and management were largely acceptable and feasible.

However, fidelity was initially more challenging for staff when it required significant changes to existing practices for detection and management of postpartum hemorrhage.

Findings from the formative research helped to identify potential implementation issues and enabled refinement and increased preparedness before a larger-scale randomized trial.

Collaborations across research disciplines and with health care providers enhance the development, design, and dissemination of new clinical interventions and their implementation strategies.