Table 2.

Consensus-based research priorities (phase 3) related to World Health Organization Labour Care Guide (WHO LCG)

Consensus-based theme	Consensus-based research avenue	Why?	What is needed?
1. Optimise implementation strategies of WHO LCG	What are the most effective approaches* to implement WHO LCG with high fidelity among different cadres, levels of care and settings? *e.g., education and training, monitoring and feedback, digital LCG, ownership of the WHO LCG, and presentation in a health facility by the woman	• To optimise strategies to introduce and sustain implementation of the WHO LCG • To improve understanding of facilitators and barriers, to develop implementation strategies to optimise introduction, scale-up and sustainability of the WHO LCG, in different settings and among different cadres of health workers	• Studies to assess barriers and facilitators for introducing and using WHO LCG, acceptability, factors affecting use and compliance, health workers' attitudes, education and training needs, behaviour changes and women's experience • Design and evaluate WHO LCG implementation strategies focusing on achieving adoption and high fidelity with WHO LCG use and improvement of process outcomes, in different settings • Compare different WHO LCG implementation strategies, focusing on achieving optimal adoption and high-fidelity use of the WHO LCG and improving process outcomes • Understand the effect of the use of WHO LCG on knowledge, attitudes, and intrapartum care practices among different health cadres • Understand approaches to engage with women and communicate about the importance of respectful labour monitoring • Consideration should be given to multi-phased studies, in a variety of levels of care and settings, including: – Pre-implementation phase: introductory pilot in a small sample of women or health facilities or both – Formative phase to co-develop the accompanying implementation strategies • Rigorous monitoring and evaluation of "real-life" WHO LCG implementation in health facilities and at the sub-national or national levels • Proposed research designs include: – Quantitative (e.g., surveys, before-after, interrupted time series) – Qualitative studies – Mixed-methods studies
2. Improve understanding of the effect of WHO LCG on outcomes	What is the effect of the WHO LCG on maternal and perinatal health outcomes, and the process and experience of labour and childbirth care*? * short-term maternal and perinatal health, provision of care/use of interventions, experience of care	••••To increase understanding of the effectiveness of WHO LCG on providing evidence-based intrapartum care, reducing unnecessary interventions, and improving maternal and perinatal health, experience of care and process outcomes	• Evaluate the effectiveness of introducing WHO LCG on maternal and perinatal health outcomes, process outcomes, and experience of care in different settings • Multi-country, multi-phased studies, in a variety of levels of care and settings, including: – Formative phase to co-develop the accompanying implementation strategies to optimise effects of WHO LCG; especially the development of a context-specific implementation strategy, including complex interventions – Implementation and evaluation of WHO LCG implementation strategy targeting labour and childbirth processes or outcomes or both • Proposed research designs include: – Stepped wedge trials – Participant-action-research cycles with women and health workers – Observational studies: before-after, interrupted time series – Modelling studies
3. Assess the effect of the WHO LCG in special situations or particular settings	Is the use of the WHO LCG to monitor labour progress feasible, safe and effective in improving outcomes in special situations* or particular settings**? * e.g., induction of labour, breech presentation, premature labour, epidural analgesia, twin pregnancy, previous caesarean section **e.g., limited or no access to caesarean section, remote areas, low-resource or highly medicalized settings	• To increase understanding of the feasibility, safety and effectiveness of WHO LCG in special situations or particular settings where referral to a higher level of care may be required	• Evaluate safety, efficacy, and effectiveness of introducing WHO LCG on maternal and perinatal health outcomes, process outcomes, and experience of care in special situations or particular settings. This may require the design and evaluation of an optimised tool and implementation strategy focused on addressing the issues related to the special situations or particular settings to maximise the effects of WHO LCG • Understand unintended consequences of the introduction and use of WHO LCG in special situations or particular settings • Efficacy studies comparing different alert thresholds for the management of special situations or in particular settings • Proposed research designs include: – Randomised controlled trials – Modelling studies
4. Understand effects of WHO LCG on organisation of care and resource requirements	What is the effect of the WHO LCG on the organisation of labour and childbirth care* in various levels of care and different settings? * e.g., referrals, teamwork, patient flow, human and physical resource requirements, shared decision making between the woman and maternity care provider	• To optimise allocation of resources and organisation of labour and childbirth care	• Design and evaluate strategies to optimise organisation of care and allocation of resources during labour and childbirth care • Understand unintended consequences of the introduction and use of WHO LCG in the organisation of care (e.g., overcrowding of labour ward due to longer labours) • Studies to assess barriers and facilitators, acceptability, health workers' attitudes, behaviour changes and women's experience • Proposed research designs include: – Quantitative (e.g., surveys, before-after, interrupted time series) – Qualitative – Mixed-methods studies
5. Assess the economic impacts of the W.HO LCG	How cost-effective is the WHO LCG in various levels of care and different settings?	• To inform decision-making about implementing strategies for introducing and sustaining the use of WHO LCG	• Understand the economic impact of introducing and using WHO LCG • Understand the economic impact of different strategies introducing and using WHO LCG • Cost estimates of introducing and sustaining the use of WHO LCG, and its implementation strategies • Proposed research designs include: – Resource implications, cost evaluations and cost-effectiveness studies embedded in studies on the effects of WHO LCG on outcomes, including evaluation of implementation strategies – Cost evaluation modelling