Table 1 Adaptation to create the BetterBirth (BB) intervention package used in the randomized control trial
| Â | Karnataka Pilot | First adaptation | Second adaptation | RCT |
|---|---|---|---|---|
Leadership engagement | Study lead introduced to district and facility leadership | Non-standardized introduction to district and facility leaders | Formalized introduction at district and facility including strong focus on motivation to drive adoption | Same as in phase II |
Education of facility staff | 1-day training on the SCC supported by instructional video, and hands-on simulation | 3-day training for staff (2 days didactic, 1-day coached practice using the SCC) | Semi structured launch including 1–2-day workshop introducing SCC, problem solving, and strong focus on motivation including video and anthem | Structured 2-day launch with increased focus on implementation of the SCC with day 2 on-site for official start |
Coaching support | Core team of head of the hospital and senior physician and labor nurse supplemented by physician from the study team | Physician-led team of physician and nurses coaching birth attendants | Peer-to-peer model: Nurse coaches for birth attendants (behavior change), physician coach facility leader (systems change and SCC leadership), and childbirth quality coordinator | Same with additional focus on district lead to build support for SCC |
Coaching provided during normal clinical routines supplemented every 2 weeks by study physician | Coaching provided Every 1–2 weeks for 4–6 weeks | Coach training using standardized curriculum focused on coaching skills to drive behavior change and barriers framework (opportunity, ability, motivation) with strong focus on motivation | ||
Coach training through review of SCC | Coach training through 2-day, on-site workshops focusing on clinical skills | Coach training focused more on QI approaches and behavior change | ||
Data feedback loop | Subset of baseline observation data feedback to staff to identify quality gaps | None | Paper-based system used to capture and review observation data by coaching team to identify persisting gaps and behavior change. Apps used to capture study-related data | Robust app-based system to provide real-time data feedback on coach observations and essential birth supplies to BB team, facility, and district. All study data continued to be captured by existing apps |
Safe birth supplies (SBS) availability | Largely available | Supply chain gaps | Increased focus of coach TL to help the facility head and district leaders leverage existing resources to address gaps | Strengthened focus for coaching and advocacy at facility and district levels for strengthening EBS availability |