Equitable Implementation of Obstetric Life Support in Rural and Low-Access Areas ID 4041

INTRODUCTION: Obstetric Life Support (OBLS) is an evidence-based, interdisciplinary simulation-based curriculum to train prehospital and hospital-based health care workers (HCWs) on prevention, recognition, and management of maternal medical emergencies. We identified barriers and facilitators to implementing OBLS in rural and low-resource settings to inform adaptations for optimizing medical emergency education in these contexts. METHODS: We conducted a nationwide survey (n=122) of administrators and HCWs in rural settings, exploring Consolidated Framework for Implementation Research (CFIR) elements that may influence implementation outcomes across multiple levels. Focus groups with 15 participants discussed strategies for promoting OBLS adoption, implementation, and sustainability. RESULTS: Prehospital and hospital-based participants found the OBLS learning objectives and content highly appropriate and acceptable but expressed concerns regarding feasibility in their work contexts. Focus groups revealed salient CFIR domains: 1) intervention characteristics: evidence strength and quality, relative advantage, design quality and packaging, and cost; 2) inner setting: implementation climate and readiness for implementation; and 3) outer setting: patient needs and resources, and external policy and incentives. Resource constraints were perceived to be significant barriers, especially time, staffing, space, and equipment. Suggested adaptations included the following: development of eLearning course modules, shortened in-person component, a web-based megacode evaluation tool, and an implementation toolkit to facilitate planning, monitoring, and change management. Participants also highlighted the importance of local champions to drive implementation and endorsed a train-the-trainer approach to build local capacity and ensure sustainability. CONCLUSIONS/IMPLICATIONS: Equitable scale-up of OBLS requires an implementation plan that considers the context, delivery mechanisms, and resource requirements of the training program.