Summary:

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

The authors present the design of 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 this implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be collected. 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.

Authors: Dumont, Alexandre; Betrán, Ana Pilar; Kaboré, Charles; De Loenzien, Myriam; Lumbiganon, Pisake; Bohren, Meghan A; Mac, Quoc Nhu Hung; Opiyo, Newton; Carroli, Guillermo; Annerstedt, Kristi Sidney; Ridde, Valéry; Escuriet, Ramón; Robson, Michael; Hanson, Claudia; The QUALI-DEC research group