@article{fdi:010079740,
  title = {{I}mplementation 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},
  author = {{D}umont, {A}lexandre and {B}etran, {A}. {P}. and {K}abore, {C}. and {L}oenzien, {M}yriam de and {L}umbiganon, {P}. and {B}ohren, {M}. {A}. and {M}ac, {Q}. {N}. {H}. and {O}piyo, {N}. and {C}arroli, {G}. and {A}nnerstedt, {K}. {S}. and {R}idde, {V}al{\'e}ry and {E}scuriet, {R}. and {R}obson, {M}. and {H}ansen, {C}. and {QUALI}-{DEC} {R}es {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {W}hile cesarean sections ({CS}s) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries ({LMIC}s). {U}nnecessary {CS} diverts scarce resources and thereby reduces access to healthcare for women in need. {A}rgentina, {B}urkina {F}aso, {T}hailand, and {V}ietnam are committed to reducing unnecessary {CS}, but many individual and organizational factors in healthcare facilities obstruct this aim. {N}onclinical interventions can overcome these barriers by helping providers improve their practices and supporting women's decision-making regarding childbirth. {E}xisting evidence has shown only a modest effect of single interventions on reducing {CS} rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. {T}he aim of this study is to design, adapt, and test a multifaceted intervention for the appropriate use of {CS} in {A}rgentina, {B}urkina {F}aso, {T}hailand, and {V}ietnam. {M}ethods: {W}e designed an intervention ({QUALI}ty {DEC}ision-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 our implementation strategy, and information regarding its impact on relevant maternal and perinatal outcomes will be gathered. {T}he 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. {D}iscussion: {T}here is urgent need for interventions and implementation strategies to optimize the use of {CS} while improving health outcomes and satisfaction in {LMIC}s. {T}his can only be achieved by engaging all stakeholders involved in the decision-making process surrounding birth and addressing their needs and concerns. {T}he study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. {I}t will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike.},
  keywords = {{U}nnecessary cesarean section ; {Q}uality of care ; {S}hared decision-making ; {N}onclinical intervention ; {H}ealthcare organization ; {L}ow- and middle-income countries ; {ARGENTINE} ; {BURKINA} {FASO} ; {THAILANDE} ; {VIET} {NAM}},
  booktitle = {},
  journal = {{I}mplementation {S}cience},
  volume = {15},
  numero = {1},
  pages = {72 [14 p.]},
  ISSN = {1748-5908},
  year = {2020},
  DOI = {10.1186/s13012-020-01029-4},
  URL = {https://www.documentation.ird.fr/hor/fdi:010079740},
}