Table 4.

Identified requirements to inform further prototype iterations based on qualitative analysis of the think-aloud exercises and follow-up interviews

Requirement	Summary of supporting data
The chart must minimise duplication of effort	Participants stressed how any new tool and system must reduce rather than increase burden on maternity professionals, including fitting it with existing required intrapartum documentation.
The chart must contain clearly defined parameters	Participants identified potential for confusion and variation as a result of poorly defined or operationalised clinical risk factors.
The content and layout of the chart must reflect workflow	Participants expressed a diversity of opinions on which ordering of observed risk factors would be the easiest to complete within clinical practice. The prototype would benefit from further understanding the optimal ‘flow’ of information on the charts.
The chart must include robust escalation processes	Ensuring escalation processes were explicit was important to all participants. The prototypes led to queries around escalation. For example, how best to follow recommended escalation practices as set out within the chart, particularly when different combinations of circumstances may lead to more than one request for senior review in quick succession.
Instructions for use of the chart should be clear and readily available	Use of the prototypes clarified that all users would require guidance on exactly what to write in or mark within each section, and to ensure clarity on what each risk factor meant, as well as comprehensive training in escalation and response procedures.