The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India

Abstract

The BetterBirth Program relied on carefully structured coaching that was multilevel, collaborative, and provider-centered to motivate birth attendants to use the WHO Safe Childbirth Checklist and improve adherence to essential birth practices. It was scaled to 60 sites as part of a randomized controlled trial in Uttar Pradesh, India.

Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India

“…To support ongoing facility-level adherence to essential practices, a facility staff member was identified and trained to support SCC use after the intervention was completed. The program is described in more detail elsewhere 18 , 20 , 21 . Technical training and supplies were not provided.…”

“…Previous studies of the SCC have suggested that peer coaching based on feedback about SCC use, 18 ensuring buy-in from the larger health care system, and integrating the SCC into existing workflows 19 increased the likelihood of making real, sustained improvements in the quality of facility-based childbirth care. The BetterBirth Program—an intervention aiming for sustained SCC adoption through coaching-based implementation—was developed based on lessons learned from early implementations of the SCC and from other quality-improvement projects 20 , 21 …”

Integration of the Opportunity‐Ability‐Motivation behavior change framework into a coaching‐based WHO Safe Childbirth Checklist program in India

“…Using the OAMS framework also enabled tracking change in the types of barriers coaches faced over time. The percent of nonadherence attributable to motivation barriers decreased during the 8 months of the study—a change consistent with the focus of coaching on individual behavior change through observation, motivation, and feedback rather than on clinical skills mentoring . Similarly, the percent of EBP nonadherence attributable to opportunity barriers decreased over time, whereas the percent attributable to supplies did not.…”

“…Trained coaches (nurses) and coach team leaders (physicians or public health professionals) engaged in three main tasks at the individual and facility levels: (1) encouraging behavior change; (2) observing, documenting, and feeding back information about EBP performance and SCC use; and (3) joint problem‐solving to resolve barriers to behavior change . The coaching model was multilevel, collaborative, and person‐centered.…”

“…At each observation of a delivery attendant providing care, the coach completed an Observation Tool to Inform Support (OTIS) by recording the performance (or nonperformance) of each EBP. If, after prompting, a delivery attendant did not perform an EBP, the coach documented at least one barrier obstructing the delivery attendant's performance of the EBP and categorized that barrier according to the OAMS framework as follows . Opportunity‐related barriers were defined as environmental or contextual factors beyond an individual's control (excluding supplies or equipment); examples include inadequate time because multiple women were in labor or women were already delivering when coming into the hospital.…”