TABLE 2.

Mapping of Triangulated Findings Using BCW to Identify Proposed Implementation Strategies for the E-MOTIVE Intervention

Summary of FindingsCOM-B

Intervention

Types From BCW

Proposed Implementation Strategies for E-MOTIVE Trial Context
Need for earlier PPH detection from accurate blood loss measurement

Capability(physical and psychological)

EducationTrainingEnablement

Training of new skills to use the calibrated drape: new blood loss collection and measurement tool to prompt and facilitate earlier detection.Training of core or new skills to deliver MOTIVE bundle including simulation practice drills.

Need for training on using the new calibrated drape
Uncertainty about administering tranexamic acid when not trained to do so
Using the intervention brings challenges for staff including new skills and confidence building to deliver intervention as intended
Need for sufficient staff and adequate stocks of PPH drugs and equipmentOpportunity (social and environmental)

Environmental restructuringModelingEnablement

Introduce PPH trolley or carry case to organize PPH drugs and equipment in 1 place accompanied by a checklist detailing the medicines and equipment to be stocked (country and site specific).Team-based training with simulation practice and drills to encourage and enable better coordination, teamwork, and communication when managing a PPH.

Need for teamwork to implement intervention
Intervention use will bring about positive changes to PPH treatmentMotivation (reflective)

EducationPersuasionModelingEnablement

Introduce audit and feedback to monitor MOTIVE bundle uptake.Introduce a person in leadership role to “champion” the E-MOTIVE intervention implementation.

Uncertainty about how using the calibrated drape will fit in with current methods for collecting blood
Perceptions that intervention use can potentially reduce PPH mortality
  • Abbreviations: BCW, Behavior Change Wheel; COM-B, capability, opportunity, motivation-behavior; E-MOTIVE, early detection of PPH using a calibrated drape, followed by massage of uterus, oxytocic drugs administration, tranexamic acid administration, intravenous fluids administration, examination for identifying and managing the source of bleeding, and escalation to more advanced care, if bleeding continues despite treatment; PPH, postpartum hemorrhage.