s13012-020-01029-4
type: Article
item type: journalArticle
is part of: Implementation Science
authors: Person
  surname: Dumont
  given name: Alexandre
authors: Person
  surname: Betrán
  given name: Ana Pilar
authors: Person
  surname: Kaboré
  given name: Charles
authors: Person
  surname: de Loenzien
  given name: Myriam
authors: Person
  surname: Lumbiganon
  given name: Pisake
authors: Person
  surname: Bohren
  given name: Meghan A.
authors: Person
  surname: Mac
  given name: Quoc Nhu Hung
authors: Person
  surname: Opiyo
  given name: Newton
authors: Person
  surname: Carroli
  given name: Guillermo
authors: Person
  surname: Annerstedt
  given name: Kristi Sidney
authors: Person
  surname: Ridde
  given name: Valery
authors: Person
  surname: Escuriet
  given name: Ramón
authors: Person
  surname: Robson
  given name: Michael
authors: Person
  surname: Hanson
  given name: Claudia
authors: Person
  surname: The QUALI-DEC research group
title: Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial
abstract: Background While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand, and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstruct this aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions on reducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand, and Vietnam. Methods We designed an intervention (QUALIty DECision-making—QUALI-DEC) with four components: (1) opinion leaders at heathcare facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decision analysis tool to help women make an informed decision on the mode of birth, and (4) companionship to support women during labor. QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals, and organizations and account for the local environment, needs, resources, and social factors in each country. Discussion There is urgent need for interventions and implementation strategies to optimize the use of CS while impro…
date: 2020-12
date submitted: 2020-11-14 17:53:58
short title: Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries
language: en
library catalog: Crossref

Implementation Science
type: Journal
volume: 15
number: 1
identifier: DOI 10.1186/s13012-020-01029-4
identifier: ISSN 1748-5908