Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study

Figures & data

Figure 1. The PartoMa intervention’s programme theory. It is hypothesized that the intervention, with embedded co-creation, improves clinical practice and the desired health and health system outcomes through a reconfiguration of interacting mediators, which are divided into practice theory’s five analytical domains: Meaning, Materiality, Competence, Motivation, Relations as well as other life practices. These domains are further explained in Figure.

Figure 2. Overview of the expected socio-psychological mechanisms the intervention will facilitate using elements of practice theory.

Table 1. Overview of the four steps of the PartoMa scale-up study (I. situational analysis, II. Co-Creation, III. Intervention, and IV. Development of a framework based on findings) and the qualitative components associated with each phase

Phase	What	Why	How	Where
I. Situational analysis	Understand how women, birth attendants and hospital managers experience, interpret and engage with current birth care and postpartum clinical care.	To explore the role of people, structures and materialities in shaping the patterns of daily hospital life that affect how intra- and postpartum care is clinically practiced before the intervention.	Through in-depth interviews, FGDs and observations.	Two hospitals in Dar es Salaam.
II. Intervention co-creation	(A) Develop context-modifications for the PartoMa intervention of CPGs and training to reflect birth attendants and labouring women’s needs and circumstances. (B) Understand the components of the intervention that survive between settings; explore resources and experiences hospital stakeholders bring to the process; and how co-creators experience the co-creation process.	(A) To make the PartoMa intervention relevant to the Dar es Salaam hospitals setting. (B) To capture and understand the process of co-creating the PartoMa guidelines to fit the local realities.	(A) Through iterative cycles of focus group evaluation, intervention modifications and external peer review. (B) Through an ethnographic approach, including observations and FGDs.	The five selected hospitals in Dar es Salaam, making one adapted PartoMa intervention.
III. Intervention implementation and evaluation	Understand opportunities and challenges in the implementation and scale up of the PartoMa intervention.	To unpack pathways and contextual factors affecting engagement with the PartoMa guidelines.	Through in-depth interviews and observations.	Two hospitals in Dar es Salaam.
IV. Development of framework	Zoom out and utilize the findings of the process and implementation of PartoMa in order to make them attainable for other settings.	To develop a framework for co-creating and implementing CPGs and associated training.	By utilizing the findings from step I, II and III.	The five selected hospitals in Dar es Salaam.