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Implementation strategies for the WHO Safe Childbirth Checklist: a scoping review.
Zenewton André da Silva Gama1,2, Katherine E A Semrau2,3, Tatyana Maria Silva de Souza Rosendo4
1Departamento de Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Brazil zenewton.gama@ufrn.br.
BMJ Open
|December 29, 2025
Summary
Implementation of the WHO Safe Childbirth Checklist (SCC) uses varied strategies, but reporting is insufficient for comparison. Prioritizing specific strategies and standardized reporting can improve adoption and fidelity of the Safe Childbirth Checklist.
Area of Science:
- Healthcare Quality Improvement
- Implementation Science
- Maternal Health
Background:
- The WHO Safe Childbirth Checklist (SCC) aims to enhance intrapartum care quality and safety.
- Implementation strategies for the SCC are diverse but inconsistently described, impacting adoption and fidelity.
Purpose of the Study:
- To map the landscape of SCC implementation strategies.
- To explore the relationship between reported strategies, adoption, and fidelity.
Main Methods:
- Scoping review of 34 studies (2009-2024) reporting SCC implementation in healthcare settings.
- Utilized the Expert Recommendations for Implementing Change (ERIC) taxonomy to code strategies.
- Analyzed adoption and fidelity using Proctor's implementation outcomes and explored implementation intensity.
Main Results:
- Identified 24 distinct ERIC strategies across 19 SCC implementation projects in 16 countries.
- Common strategies included educational meetings, audit/feedback, supervision, and leadership.
- No consistent association found between implementation intensity and adoption or fidelity; adaptations were common but reporting was heterogeneous.
Conclusions:
- SCC implementation relies on multicomponent strategies, but insufficient reporting hinders comparability.
- Recommended prioritizing specific strategies like team training, champions, audit/feedback, light adaptations, and supervision.
- Advocated for theory-informed frameworks and standardized reporting tools (e.g., TIDieR/StaRI) to enhance transparency and scalability.
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