Customization and acceptability of the WHO Labor care guide to improve labor monitoring among health workers in Uganda. An Iterative Development Study

Background: Cognisant of the persistent maternal and perinatal mortality rates, the WHO has called for adoption and evaluation of new adaptable and context-specific health solutions to improve labor monitoring and health outcomes. We aimed at customizing and refining the new WHO labour care guide (LCG) to suite health care provider (HCP) needs in monitoring labour in Southwestern Uganda. Methods: We used an iterative approach to customize and refine the new WHO LCG. Between 1st July 2023 and 30th November 2023, we conducted; 1)30 stakeholder interviews to identify user needs and challenges, and inform the first LCG modifications; 2)10 HCP exit interviews to obtain feedback and modify LCG prototype one; 3)Two focus group discussions following use of prototype two to identify any further user needs; 4)Exit expert panel interviews involving HCPs to refine LCG components; 5)Pilot testing of final prototype among 40 HCPs; 6)Final panel reviews from two expert conferences, the National Safe Motherhood Conference, and Association of Obstetricians and Gynaecologists of Uganda to refine/consolidate modifications of final prototype for Uganda, ready for evaluation. Results: A total of 120 HCPs and MOH officials previously exposed to the new WHO LCG, with median age of 36 years (IQR;26-48) were interviewed. Over 53 modifications were made to tailor the WHO LCG into the modified LCG prototype for Uganda including; 1)Adjusting observation ordering to improve flow, clarity, and facilitate an easy user interface; 2)Inclusion of vital socio-demographic data compatible with existing programs in Uganda to prompt risk identification; 3)Modification of medications, baby-mother parameters/observations to suit local context; and 4)Inclusion of key cues to action, clinical notes and labour outcome data to facilitate auditing, accountability, reference, utilization and immediate postpartum care. All HCPs found the modified LCG useful, easy to use, appropriate, comprehensive, inclusive and would recommend it to others for use. Over 80% HCPs reported they took <2 minutes to plot/fill all observations on the LCG after assessment. Conclusions. Active involvement of targeted end-users in customizing the LCG was observed to improve inclusiveness, ownership, comprehensiveness, acceptability, engagement and uptake. The modified LCG prototype was found to be simple, appropriate and easy-to-use. Further research to evaluate this LCG prototype feasibility and effectiveness is needed.