Integration of the Opportunity‐Ability‐Motivation behavior change framework into a coaching‐based WHO Safe Childbirth Checklist program in India

Abstract

ObjectiveTo evaluate whether integration of the Opportunity‐Ability‐Motivation plus Supplies (OAMS) framework into coaching improved the delivery of essential birth practices in a low‐resource setting.MethodsThis prospective mixed‐methods study used routine coaching visit data obtained from the first eight intervention facilities of the BetterBirth trial in Uttar Pradesh, India, between December 19, 2014, and October 21, 2015. The 8‐month intervention was peer coaching that integrated the OAMS framework to support uptake of the WHO Safe Childbirth Checklist. Descriptive statistics were used to measure nonadherence to essential birth practices. The frequency and accuracy of coaches’ coding of barriers and the appropriateness of chosen resolution strategies to measure feasibility, acceptability, and fidelity of using OAMS, were assessed.ResultsCoaches observed 666 deliveries, including 12 602 practices. Overall, essential practice nonadherence decreased from 15.6% (262/1675 practices observed) to 4.5% (4/88 practices) (P<0.001). Of the 1048 barriers identified, opportunity (556 [53.1%]) and motivation (287 [27.4%]) were the most frequently reported categories; the frequency of both decreased over time (P=0.003 and P<0.001, respectively). The coaches appropriately categorized 930 (99.8%) of 932 barriers and provided an appropriate strategy for 800 (85.8%). The commonest reason for unaddressed barriers was lack of coaching opportunities.ConclusionSuccessful integration of OAMS framework into delivery attendant coaching enabled coaches to rapidly diagnose barriers to practice adherence and develop responsive strategies.ClinicalTrials.gov NCT2148952 (WHO Universal Trial Number: U11111‐1315‐647).

Coaching Intensity, Adherence to Essential Birth Practices, and Health Outcomes in the BetterBirth Trial in Uttar Pradesh, India

“…In this study, all facilities were primary-level health facilities located in Uttar Pradesh, and all coaching was provided by external peer coaches according to the opportunity-ability-motivationssupplies framework. 33 Consequently, we do not know the extent to which the relationships observed in this analysis can be generalized to other settings or to other forms of coaching. Contextual factors, including staffing levels, facility infrastructure, and the interactions between coaching activities and traditional supervision processes may modify the effectiveness of coaching.…”

“…The BetterBirth Program used an engagelaunch-support model, which has been previously described in detail. [32][33][34] Briefly, district-and facilitylevel leadership were introduced to the BetterBirth program and engaged to identify priority areas for improvement related to the SCC. Each facility held an educational and motivational launch event to train birth attendants on using the SCC.…”

“…Coaching followed an "opportunity-abilitymotivations-supplies" framework adapted from previous behavior change models. 33,36,37 In this framework, coaches motivated birth attendant behavior change using techniques such as storytelling and positive acknowledgment to emphasize the importance of adopting EBPs to meet national guidelines and save lives. They also observed deliveries, collected data, and provided real-time feedback on current adherence to EBPs; identified existing opportunity-, ability-, motivation-, or supply-related barriers to EBP adherence; and engaged in group problem solving to address these barriers.…”

“…Other examples of how coaches addressed specific barriers can be found elsewhere. 33,38 As part of the study design, coaches did not directly provide additional technical training or coach on clinical quality but did advocate with facility leaders (lady medical officers or medical officers incharge) for additional training opportunities or engage in role playing to address ability-related barriers.…”

Availability of Safe Childbirth Supplies in 284 Facilities in Uttar Pradesh, India

“…Thus, supply stockouts pose a significant barrier to delivery of high quality maternal and neonatal care. During the BetterBirth trial, supplies were observed as an obstacle to providing care in 10% of coaching sessions (Hirschhorn et al 2018).…”