Table 2 Definition, theory, and assumptions of each component of the QUALI-DEC intervention

Opinion leaders [20]

Healthcare leaders are identified by their colleagues or local authorities in participating healthcare facilities as being respected clinicians and effective communicators.

Power/interaction model of interpersonal influence [21]

Adherence to guidelines and clinical audit are reinforced through the interaction and influence of reputable culture change agents.

Audit and feedback [22]

Indications of CS and CS practice among low-risk women are audited by a local committee, with timely feedback to all healthcare professionals.

Constructivist learning [23]

The way knowledge is absorbed, processed, and retained results from cognitive, emotional, and environmental influences, and change occurs through the active involvement of professionals in analyzing their practices.

Decision analysis tool (DAT) [24]

A meaningful dialog between providers and women on preferences, options, concerns, risks and benefits of planned CS vs. planned vaginal delivery leads to an informed and more satisfactory decision for both parties.

Decision theory [25]

A decision aid benefits women and healthcare workers by facilitating a process of informed decision-making, in the context of improved knowledge and overt consideration of women’s individual fears, values, and needs surrounding birth.

Companionship during labor [11]

Through the process of implementation, professionals decide on the modification of existing systems, structures, or tasks to offer women and their relatives the possibility of having a companion of choice during labor and childbirth.

Convoy model of social relations [25, 26]

Overuse of CS can be prevented by improving the design of health systems and processes to better respond and adapt to the needs of women and their relatives regarding social support during labor and childbirth.