Table 5 Interview themes, categories and definitions

Development of national maternal health

guidelines

   · Development Process

· the steps taken to develop and produce guidelines

   · Stakeholder participation

· level of involvement of stakeholders in guideline development

   · National guidelines' relation to WHO recommendations

· how contents of national CPGs compare with WHO PCPNC guidelines

Health workers' access to guidelines

Perceived access barriers

   · Distribution

· physical distribution of printed guidelines

   · Staff mobility

· frequent changes of work-place displaces guidelines from health facilities

   · Health workers' participation in training courses

· course curricula frequently used as CPGs, health workers dependent on courses to obtain up-to-date guidelines

Perceived solutions to improve access:

   · Pocket sized guidelines

· personal portable guidelines for every health worker

   · Wall posters

· guidelines in a poster format increases availability for everybody working in the health facility

Health workers' use of guidelines

   · Low levels of guideline adherence

· perception among key informants of an overall low use of guidelines by front-line health workers

Perceived reasons for low guideline adherence:

   · Attitudes towards continuing education

· health workers do not usually update their knowledge independently from organised training

   · Effects of training

· limited change in clinical practice following courses

   · Format of guidelines - lack of usability

· presence of flow-charts, algorithms etc.

   · Negative beliefs about using guidelines during patient consultations

· perception that patients' trust will be undermined if health workers use CPGs during consultations