Overview of Implementation Outcomes Across Observations, Interviews, Audit of Drug Use and Assessment of Implementation Outcomes
Implementation Outcome | Observationsa(18 observations of vaginal birth, 7 PPHs) | Interviews (n=58) | Overall Assessment of Implementation Outcomesb |
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Fidelity | |||
Calibrated drape |
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All participants reported always using the calibrated drape to detect PPH. (Noted: discrepancy between self-reported and observed practice). |
Use of drape: Medium to high fidelity Placing of drape by regular staff not employed by E-MOTIVE: Low to medium fidelity |
MOTIVE components |
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Use of MOTIVE: High fidelity |
Training |
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Initial training: High fidelityFollow-up skills sessions and PPH simulation:Low to mediumfidelity |
PPH trolley/carry case |
| All participants said there was a PPH trolley available on the labor ward; however, some participants said it was not always used. |
Availability of trolley:High fidelityUse of trolley:Low fidelity |
Champions | NA | Number of participants reporting champions at site and number of champions in situ (if known) were:
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Champions in place:High fidelity |
Audit and feedback | NA |
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Engagement with audit and feedback:Low fidelity |
Acceptability | |||
Calibrated Drape and MOTIVE components | NA | Across all countries, participants were satisfied with using the calibrated drape to detect PPH and using the MOTIVE components to treat PPH. | High acceptability |
Training, PPH trolley/carry case, champions and audit and feedback | NA | Across all countries, participants said the implementation strategies offered appropriate support and encouragement to improve uptake of the E-MOTIVE intervention and implementation strategies at their site. | High acceptability |
Feasibility | |||
E-MOTIVE Intervention and implementation strategies | Practical use of the E-MOTIVE intervention, attending the training by nursing staff and using PPH trolley/carry case was demonstrated at all sites. | Across all countries, participants reported it was feasible to deliver the bundle and engage with the implementation strategies. | High feasibility |
Abbreviations: CRF, case report form; NA, not assessed via observations; E-MOTIVE, early detection of postpartum hemorrhage, 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.
↵a No observation completed in Tanzania (fidelity of E-MOTIVE intervention use).
↵b Assessment of implementation outcomes (fidelity, feasibility, acceptability) criteria: low=≤50%; medium=between 51%–79% and high ≥80%.
↵c Data collected by University of Birmingham clinical trial team.