Table 2.

Key research questions for the process evaluation with corresponding pre-conditions and data sources.

Intervention pre-condition [22] as shown in ToC, Figure 1.	Key research questions	Source
Overall
●Country PIs and selected opinion leaders identify, select, and adapt clinical algorithms and protocols to local context	Which adaptations were done to implementation strategies and/or context to implement the complex intervention? When were adaptations done and why?	Formative research, stakeholder engagement reports, monitoring visits, monthly meetings
●Health workers are aware of the intervention and are willing to commit to and support it ●Healthcare facility management supports health workers and opinion leaders; they are provided sufficient and adequate resources	What were the key internal and external factors impacting motivation, morale, capacity for behaviour change among healthcare providers?	Survey evaluating the stakeholder training Interviews with healthcare providers and opinion leaders
N/A	Is QUALI-DEC cost-effective?	Monitoring visits, financial and project reports, the postpartum survey, and interviews with project staff
Opinion leader
●Country PIs and selected opinion leaders identify, select, and adapt clinical algorithms and protocols to local context. ●Formation of audit committee ●OLs identifies knowledge gaps and meet training needs in maternity team.	How was the intervention Opinion leader implemented? What was the quality and reach of the opinion leader intervention?	Process/outcome indicators (table 4) Interviews with opinion leaders
	What were opinion leaders’ perceptions of their own role and capacity to bring about change (in relation to the 3 other intervention components)?
Audit and feedback
●Country PIs and selected opinion leaders identify, select, and adapt clinical algorithms and protocols to local context. ●Audit committees perform CS audits and provide feedback to Health workers. ●Audit and feedback lead to self-reflection and action	How was the intervention Audit and Feedback implemented? What was the quality of the Audit and feedback?	Process/outcome indicators (table 4) Interviews with healthcare providers and opinion leaders
	How did healthcare providers understand and engage with the RTGCS and related clinical algorithms?
	How were the audit and feedback sessions perceived by opinion leaders and health workers?
	Did feedback lead to increased adherence to clinical algorithms? Why? Why, not?
Labour companionship
●Country PIs and selected opinion leaders identify, select, and adapt clinical algorithms and protocols to local context. ●Health workers appreciate the importance of labour companionship; they facilitate and promote quality labour companionship. ●Pregnant women are aware of the option labour companionship, companions are welcome and supported	How was labour companionship implemented and adapted in participating healthcare facilities?	Process/outcome indicators (table 4) Interviews with healthcare providers and postpartum women Postpartum survey II
	What was the quality and reach of the labour companionship intervention?
	How was companionship perceived and experienced by women, companions, health workers and healthcare facility management?
Decision analysis tool
●Country PIs and selected opinion leaders identify, select, and adapt clinical algorithms and protocols to local context	How/where was the DAT implemented in participating healthcare facilities and in primary healthcare? What was the reach of the DAT?	Process/outcome indicators (table 4) Postpartum survey II Interviews with healthcare providers and postpartum women
●Health workers promote and use the DAT booklet/app in their ANC practice, communication material in relevant places. ●Pregnant women use the DAT booklet/app in their CS decision-making and communication with HCP	How did health workers and women engage with and perceive the use of the DAT including its impact on the patient provider-relationship and decision-making?