Introducing the E-MOTIVE Bundle for the Management of Postpartum Hemorrhage: Perceptions of Health Professionals and Perceived Barriers to Its Implementation in Sub-Saharan Africa.

BACKGROUND: The E-MOTIVE bundle that includes objective measurement of early blood loss has been found to be effective in the early detection and management of PPH and the reduction of maternal mortality because of PPH. The aim of this study was to determine the perception of trained health professionals toward the E-MOTIVE bundle intervention for PPH as well as to explore perceived barriers to its implementation in Ethiopia. METHODS: This mixed-methods study was conducted at Saint Paul's Hospital in Addis Ababa, Ethiopia, from February 1, 2024, to May 31, 2024. Data were collected from 80 health professionals using a structured questionnaire for the quantitative component, and seven in-depth interviews (IDIs) were conducted for the qualitative component with stakeholders working in maternal health. Quantitative data analysis was performed using SPSS Version 23.1, whereas qualitative data were analyzed thematically using ATLAS.ti Version 7.0.71. Written consent was obtained from study participants. RESULTS: Only 21% of the health professionals had heard of E-MOTIVE prior to the training. More than 90% of the health professionals and all of the participants of the IDIs believed that the E-MOTIVE bundle comes with a novel approach for early detection of PPH and is feasible and acceptable. Most perceived that the E-MOTIVE approach is easy to understand and motivating for staff. The major perceived barriers to the implementation of the bundle were as follows: the huge resource implications of the bundle (85% of respondents), the need for increased clinical engagement (66%), increased labor ward stays of mothers (35%), and the need for more clinical documentation (38%). Other barriers cited by IDI participants were as follows: the potential for creating a displeasing labor and delivery setup, unavailability of the blood collection drapes and challenges with their local production, concern about the cultural acceptability of the drapes, and the need to align with national guidelines on PPH management. CONCLUSIONS: The E-MOTIVE bundle approach for PPH management is feasible and acceptable. However, its successful implementation hinges on coordinated efforts to incorporate it into guidelines, overcome resource limitations, and implement behavior change strategies targeted toward healthcare professionals and delivering mothers.