Exploring potential opportunities and strategies of using the new WHO Labour Care Guide to improve labour monitoring and health outcomes among health care providers in Uganda: A Qualitative Study

Abstract

Abstract Background: Prolonged labour remains a major pathway to common labour complications. WHO Labor Care Guide (LCG) has been developed for health care providers (HCPs) to timely identify deviations from normal through regular assessment. We explored potential opportunities and strategies of using this LCG to improve labour monitoring among HCPs and MOH officials in Uganda. Methods: Between June and September 2023, we purposively selected and conducted in-depth qualitative face-to-face interviews with 30 HCPs, and 6 MOH/WHO officials exposed to the LCG in Uganda. Interviews were digitally recorded in a private setting following informed consent. Translated transcripts were generated and coded. Coded data was iteratively reviewed and sorted to inductively construct categories describing multilevel factors that might influence HCP’s sustained engagement in labour monitoring, LCG uptake and implementation. Results: The median age of the interviewed HCPs was 36 years(IQR,27-54). All participants demonstrated great enthusiasm, describing the new LCG as a simple, better, detailed, easy-to-use and comprehensive tool that could quickly and accurately detect prolonged labor for timely management, if modified appropriately. HCPs identified LCG’s potential to facilitate sustained use through perceived ability to; correctly define active labour at a more acceptable 5cm of cervical dilatation, have major labour parameters recorded on one-A4-paper for easy comparison and reference, stimulate HCP-patient-labour companion interaction for social support, undergo customization to address user needs, enhance accountability and reduce over-documentation, and workloadsince the same A4 paper could capture all the necessary details needed to make a “one-stop quick and effective clinical decision”. HCPs underscored the role and sustained benefitsof off-site training, team building, guidelines accessibility, real-time feedback, peer mentorships and championships. Noted LCG pitfalls included; small fonts, observation ordering that needed modifications to facilitate an easy-to-use interface, missing record of social-demographic and key outcome data, plus fields/parameters deemed redundant/inappropriate. Conclusion: Our data demonstrates a responsive, enthusiastic and supportive environment that has potential to facilitate LCG customization, uptake and scale up. The high LCG expectations are important considerations in developing sustainable and acceptable implementation strategies that meet user needs. More work is needed to refine and evaluate the tool’s effectiveness in improving labour monitoring in Uganda.