PT - JOURNAL ARTICLE AU - Smith, Jana AU - Lennon, Marie Sandra AU - Kau, Madeline AU - Ranjalahy, Anja Noeliarivelo AU - Ingabire, Liliane AU - Warren, Charlotte AU - Flanagan, Sara V. TI - Harnessing the Power of Behavioral Science: An Implementation Pilot to Improve the Quality of Maternity Care in Rural Madagascar AID - 10.9745/GHSP-D-23-00007 DP - 2023 Nov 30 TA - Global Health: Science and Practice PG - e2300007 VI - 11 IP - Supplement 1 4099 - http://www.ghspjournal.org/content/11/Supplement_1/e2300007.short 4100 - http://www.ghspjournal.org/content/11/Supplement_1/e2300007.full SO - GLOB HEALTH SCI PRACT2023 Nov 30; 11 AB - Key FindingsUsing applied behavioral science and a codesign process with health care providers, postpartum women, facility in-charges, and community members resulted in cocreation and testing of 4 interventions that aimed to address providers' behavioral barriers to their compliance with management of postpartum hemorrhage (PPH) protocols and improve the quality of care during labor and delivery.Providers' adoption of the timers to remind them when to administer oxytocin and of the task badges to allow them to engage family members in supporting them during routine delivery was high.Providers reported high levels of satisfaction, appropriateness for the context, and feasibility of use of the timer, task badges, and glow-in-the-dark algorithm poster. However, the risk visualization exercise that intended to convey the importance of adhering to PPH management protocols faced challenges in implementation and delivery caused by the COVID-19 pandemic.Key ImplicationsPolicymakers and program designers seeking to improve quality of care should systematically consider challenges from a behavioral lens or employ behavioral evidence to design approaches.Behavioral science should be used to identify underlying drivers of gaps in clinical practice and to develop innovative and desirable solutions to address those gaps using a process of codesign.Background:Postpartum hemorrhage (PPH) is the leading direct cause of maternal deaths worldwide, and women in low-income countries are at particularly high risk of dying from PPH-related consequences. Most deaths can be avoided through consistent provider adherence to prevention protocols and timely, appropriate management, yet providers do not consistently adhere to these best practices.Using Behavioral Design To Develop Solutions to Improve Provider Care:We applied the behavioral design methodology to identify behavioral drivers, develop solutions, and build a program theory of change. Implementation research was conducted to understand the adoption, desirability, feasibility, and appropriateness of the solutions and explore suggestive findings related to impact. Data were collected through observation and in-depth interviews. Solutions developed included: (1) a timer to remind providers of the 1-minute window to administer oxytocin; (2) a glow-in-the-dark poster illustrating a simplified algorithm for PPH management; (3) badges to assign family members tasks to support providers during labor and delivery; and (4) a risk visualization exercise. Clinical mentors introduced the solutions during facility visits, and providers received orientation using videos. Solutions were piloted in 10 rural facilities in southeastern Madagascar during November–December 2020.Results:Providers reported high adoption of the timers and task badges during routine deliveries. They remarked on the desirability and appropriateness of the timer, task badges, and algorithm poster, as well as the value of the cocreation process. Adoption of the timer solution shows promise in having a potential positive impact on increasing the awareness of and adherence to timely oxytocin administration.Conclusion:This work highlights the promise of applying behavioral science to identify underlying drivers of gaps in clinical practice and to develop innovative and desirable solutions to address them.