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Poster Session 4

(966) Equitable Implementation of Obstetric Life Support in Maternity Care Deserts and Low Access Areas

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Andrea D. Shields, MD, MS (she/her/hers)

    Program Director, Maternal Fetal Medicine Fellowship
    University of Connecticut Health
    Avon, Connecticut, United States

    • Coauthor(s)

  • RC

    Rogie Royce Carandang, MPH, MS, PhD

    Postdoctoral Research Fellow
    University of Connecticut Health
    University of Connecticut Health, Connecticut, United States

  • AL

    Andy Lowe, BS

    Executive Director
    New England Rural Health Association
    New England Rural Health Association, Vermont, United States

  • AD

    Ann Marie Day, MBA

    Chief Operating Officer
    New England Rural Health Association
    Barre, Vermont, United States

  • TT

    Thomas Trimarco, MD

    Dartmouth Health
    Dartmouth CREST, New Hampshire, United States

  • LB

    Les R. Becker, PhD

    Sr Evaluation Scientist, MedStar Institute for Innovation, Simulation Education & Training Lab
    MedStar Health
    Rockville, Maryland, United States

  • VM

    Vincent N. Mosesso, Jr., BA, MD

    Professor of Emergency Medicine
    University of Pittsburgh
    Pittsburgh, Pennsylvania, United States

  • SC

    Shayna Cunningham, PhD

    Assistant Professor
    University of Connecticut School of Medicine
    Farmington, Connecticut, United States

Objective: Obstetric Life Support (OBLS) is an evidence-based, interdisciplinary simulation-based curriculum to train prehospital and hospital-based healthcare workers (HCWs) on prevention, recognition, and management of maternal medical emergencies. We aimed to identify barriers and facilitators to implementing OBLS in rural and low-resource settings to inform adaptations for optimizing medical emergency education in these contexts.

Study Design:

We conducted a nationwide survey (n=122) of administrators and HCWs in rural settings, exploring Consolidated Framework for Implementation Research (CFIR) elements that may influence implementation outcomes across multiple levels. Focus groups were conducted with a subset of 15 participants to discuss strategies for promoting OBLS adoption, implementation, and sustainability.

Results: Both prehospital and hospital-based participants found the OBLS learning objectives and content highly appropriate and acceptable but expressed concerns regarding the feasibility of implementation in their work contexts. Salient CFIR domains identified included: 1) Intervention Characteristics: Evidence strength and quality, relative advantage, design quality and packaging, and cost; 2) Inner Setting: Implementation climate and readiness for implementation; 3) Outer Setting: Patient needs and resources, and external policy and incentives. 

Resource constraints were perceived to be a significant barrier, especially time, staffing, space, and equipment. Suggested adaptations included the development of eLearning course modules, a shortened in-person component, a web-based megacode evaluation tool, and an implementation toolkit to facilitate planning, progress monitoring, and change management. Participants also highlighted the importance of local champions to drive the implementation process and endorsed a train-the-trainer approach to build local capacity and ensure sustainability.

Conclusion:

Equitable scale-up of OBLS requires an implementation plan that considers the training program's context, delivery mechanisms, and resource requirements.