Implementation strategies within a complex environment: A qualitative study of a shared decision-making intervention...

Area of Science:

• Healthcare Implementation Science
• Maternal Health Outcomes
• Patient-Centered Care

Background:

• Shared decision-making (SDM) offers benefits in maternity care but faces implementation challenges.
• Strategies for implementing SDM interventions are not well-documented.
• TeamBirth is an SDM solution designed to center the birthing person in decision-making.

Purpose of the Study:

• To assess the acceptability and feasibility of the TeamBirth intervention.
• To identify and describe implementation strategies for SDM in labor and delivery settings.
• To understand contextual factors influencing the adoption of TeamBirth.

Main Methods:

• Qualitative study conducted in four US hospitals.
• Interviews with 103 clinicians and 16 focus groups with 52 implementers.
• Utilized the Consolidated Framework for Implementation Research (CFIR).

Main Results:

• Clinicians and implementers valued TeamBirth for enhancing care plan clarity and centering the birthing person.
• Implementation was influenced by leadership strength, physician practice models, and quality improvement culture.
• Effective strategies included data feedback and adapting flexible components of TeamBirth.

Conclusions:

• Findings provide insights into bridging the implementation gap for SDM interventions.
• Offers practical lessons for labor and delivery units aiming to integrate SDM practices.
• Highlights the importance of context-specific strategies for successful intervention implementation.