Evaluating the WHO Labour Care Guide in clinical settings

**Project background and rationale:**The partograph is an important clinical tool for monitoring a woman’s progress during labour and childbirth that is in routine use worldwide. In 2018, WHO released updated intrapartum care recommendations that included definitions and durations of the first and second stages of labour.   A revised version of the WHO partograph – the “WHO Labour Care Guide†(LCG) – has been developed to make it easier for healthcare providers to implement these evidence-based recommendations in routine clinical practice.

The LCG has been developed using human-centred design principles, including expert consultations, international surveys and focus group discussions.  However, it is critical to ensure that the LCG is able to meet care providers’ needs in real-world clinical settings. Mixed-methods usability evaluation can provide important data on how the current LCG design can be optimised.

**Aims and Objectives:**The aim of this project is for healthcare providers to pilot-test the LCG in clinical settings, in order to evaluate its usability, feasibility and acceptability, as well as barriers and facilitators to its use.

The objectives are:

1.      To assess usability of the WHO Labour Care Guide with healthcare providers;

2.      To explore healthcare provider’s views on the feasibility and acceptability of the WHO Labour Care Guide;

3.      To explore barriers and facilitators to implementing the WHO Labour Care Guide in routine clinical practice; and

4.      To determine what (if any) improvements should be made to the WHO Labour Care Guide.

**Methods:**This is a three-step evaluation project that will be conducted in 12 health facilities across 6 countries (two facilities per country). Participating facilities are those providing at least basic emergency obstetric and neonatal care, with more than 1,000 births per year. In each facility, 10 healthcare providers (experienced in partograph use) will be purposively sampled (to ensure diversity of cadres and years of experience in labour ward) and invited to participate.

In step one, consenting providers will undergo a standardized training in correct use of the LCG, which will then be used in monitoring and managing labour and childbirth of a sample of low-risk women (each i.e. 100 women per facility).  In step 2, eligible women will be identified through screening and consent sought prior to participation. Eligible women are those in early spontaneous labour, with a singleton, cephalic, term, low-risk pregnancy in whom a vaginal birth is anticipated. Providers will complete the LCG as part of routine childbirth care. Data (non-identifiable) on women’s characteristics and birth outcomes will be collected, along with completed LCG’s. Providers will complete a short postpartum questionnaire soon after each birth (i.e. within 6 hours) on their experience with the LCG. In step 3 (once the facility target of 100 women has been reached), providers will participate in focus group discussions (FGDs, 1 per facility) to explore their views on the feasibility and acceptability of the LCG, any recommendations for change, as well as potential barriers and facilitators in implementing the LCG in their setting. FGDs will be audio-recorded and transcribed by a project staff member at each site. Providers will also complete an endline questionnaire to assess usability and provider satisfaction with the LCG.

Quantitative data (accuracy and completeness of LCGs, provider usability and satisfaction scores and birth outcomes) will be reported descriptively (overall and per site). Qualitative data on feasibility, acceptability, barriers and facilitators will be analysed using framework analysis.

**Outputs:**This project will provide data from a range of countries and perspectives on how the current iteration of the LCG can be improved. It will provide important data on the feasibility and acceptability of the LCG in these settings, as well as identifying potential barriers and facilitators to its integration into routine care.