Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May 26:12:50.
doi: 10.1186/s12978-015-0028-5.

Formative research and development of innovative tools for "Better Outcomes in Labour Difficulty" (BOLD): study protocol

Meghan A Bohren  1   2 , Olufemi T Oladapo  3 , Özge Tunçalp  4 , Melanie Wendland  5 , Joshua P Vogel  6 , Mari Tikkanen  7 , Bukola Fawole  8 , Kidza Mugerwa  9 , João Paulo Souza  10 , Rajiv Bahl  11 , A Metin Gülmezoglu  12 ; WHO BOLD Research Group
Collaborators, Affiliations

Formative research and development of innovative tools for "Better Outcomes in Labour Difficulty" (BOLD): study protocol

Meghan A Bohren et al. Reprod Health. .

Abstract

Background: Most complications during labour and childbirth could be averted with timely interventions by skilled healthcare providers. Yet, the quality and outcomes of childbirth care remains suboptimal in many health facilities in low-resource settings. To accelerate the reduction of childbirth-related maternal, fetal and newborn mortality and morbidity, the World Health Organization has initiated the "Better Outcomes in Labour Difficulty" (BOLD) project to address weaknesses in labour care processes and better connect health systems and communities. The project seeks to develop a "Simplified, Effective, Labour Monitoring-to-Action" tool (SELMA) to assist healthcare providers to monitor labour and take decisive actions more efficiently; and by developing an innovative set of service prototypes and/or tools termed "Passport to Safer Birth", designed with communities and healthcare providers, to promote access to quality care for women during childbirth. This protocol describes the formative research activities to support the development of these tools.

Methods/design: We will employ qualitative research and service design methodologies in eight health facilities and their catchment communities in Nigeria and Uganda. In the health facilities, focus group discussions (FGD) and in-depth interviews (IDI) will be conducted among different cadres of healthcare providers and facility administrators. In the communities, FGDs and IDIs will be conducted among women who have delivered in a health facility. We will use service design methods to explore women's journey to access and receive childbirth care in order to innovate and design services around the needs and expectations of women, within the context of the health system.

Discussion: This formative research will serve several roles. First, it will provide an in-depth understanding of healthcare providers and health system issues to be accounted for in the final design and implementation of SELMA. Second, it will help to identify key moments ("touch points") where women's experiences of childbirth care are shaped, and where the overall experience of quality care could be improved. The synthesis of findings from the qualitative and service design activities will help identify potential areas for behaviour change related to the provision and experience of childbirth care, and serve as the basis for the development of Passport to Safer Birth. Please see related articles 'http://dx.doi.org/ 10.1186/s12978-015-0027-6 ' and 'http://dx.doi.org/ 10.1186/s12978-015-0029-4 '.

PubMed Disclaimer

Figures

Figure 1
Figure 1
BOLD workflow and analysis plan. (Footnote: Passport to Safer Birth refers to a set of services prototypes or tools. SELMA refers to an electronic labour monitoring-to-action tool).
Figure 2
Figure 2
An example of a service design process.
Figure 3
Figure 3
BOLD iterative design process.
Figure 4
Figure 4
Draft template of user journey map.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ashford L. Hidden suffering: disabilities from pregnancy and childbirth in less developed countries. Population Reference Bureau, 2002.
    1. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33. doi: 10.1016/S2214-109X(14)70227-X. - DOI - PubMed
    1. Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, Pattinson R, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet. 2009;107(Suppl 1):5–19. doi: 10.1016/j.ijgo.2009.07.016. - DOI - PubMed
    1. Ronsmans CGW. Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1190–200. doi: 10.1016/S0140-6736(06)69380-X. - DOI - PubMed
    1. Wall SN, Lee AC, Niermeyer S, English M, Keenan WJ, Carlo W, Bhutta ZA, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet. 2009;107(Supplment 1):47–64. doi: 10.1016/j.ijgo.2009.07.013. - DOI - PMC - PubMed

Publication types