A Qualitative Study of Hospitals and Payers Implementing Community Doula Support

Area of Science:

• Maternal Health
• Healthcare Implementation Science
• Health Services Research

Background:

• Doula care significantly improves birth outcomes but remains underutilized.
• Increased demand for doula support necessitates identifying implementation barriers and facilitators.
• Hospital and payer perspectives on doula program implementation are crucial.

Purpose of the Study:

• To examine doula program implementation across hospitals and payers.
• To identify contextual factors influencing the successful integration of doula services.
• To understand varying stages of doula program implementation.

Main Methods:

• Qualitative study using focus group discussions with representatives from 4 hospitals and 2 payers.
• Doula programs categorized by implementation status: anticipated, initial, and advanced.
• Thematic analysis employing the Consolidated Framework for Implementation Research (CFIR).

Main Results:

• Key themes included the value of outcome data and anecdotal evidence for supporting doula care.
• Implementation is resource-intensive, extending beyond direct doula funding.
• Individual champions (e.g., midwives) and a supportive organizational culture are vital.

Conclusions:

• Successful doula program implementation requires combining research evidence with anecdotes to gain stakeholder support.
• Resource allocation must consider implementation support beyond just funding.
• Organizational culture critically influences doula care adoption, emphasizing health equity.