RT Journal Article SR Electronic T1 Development and Piloting of Implementation Strategies to Support Delivery of a Clinical Intervention for Postpartum Hemorrhage in Four sub-Saharan Africa Countries JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2300387 DO 10.9745/GHSP-D-23-00387 VO 12 IS 5 A1 Forbes, Gillian A1 Akter, Shahinoor A1 Miller, Suellen A1 Galadanci, Hadiza A1 Qureshi, Zahida A1 Al-beity, Fadhlun Alwy A1 Hofmeyr, G. Justus A1 Moran, Neil A1 Fawcus, Sue A1 Singata-Madliki, Mandisa A1 Wakili, Aminu Ado A1 Amole, Taiwo Gboluwaga A1 Musa, Baba Maiyaki A1 Dankishiya, Faisal A1 Atterwahmie, Adamu Abdullahi A1 Muhammad, Abubakar Shehu A1 Ekweani, John A1 Nzeribe, Emily A1 Osoti, Alfred A1 Gwako, George A1 Okore, Jenipher A1 Kikula, Amani A1 Metta, Emmy A1 Mwampashi, Ard A1 Evans, Cherrie A1 Mammoliti, Kristie-Marie A1 Devall, Adam A1 Coomarasamy, Arri A1 Gallos, Ioannis A1 Oladapo, Olufemi T. A1 Bohren, Meghan A. A1 Lorencatto, Fabiana YR 2024 UL http://www.ghspjournal.org/content/12/5/e2300387.abstract AB Key FindingsBefore 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.Key ImplicationsFindings 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.Introduction:Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania.Methods:Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity.Results:Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training).Conclusion:Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial.