Table 1.

Health worker acceptability

Question	No of studies	Evidence synthesis	Quality
Do health workers use the partograph?	n = 18	Wide variation in the reported routine use of the partograph in practice, from 8 to 80%. The partograph is more likely to be used in tertiary settings, by physicians and midwives. The partograph is more likely to be used in public facilities. Specific training in the partograph may increase use. There is some evidence, although limited, to suggest that experience does not have any impact on use. There is some evidence, although limited to suggest that confidence in using the partograph increases its use in practice.	**Low [25, 33, 36, 41, 48] *V low [24, 26, 28–32, 42, 43, 47, 66]
What are health workers’ attitudes towards the partograph?	n = 9	Evidence suggests that health workers display positive attitudes to the partograph. A positive attitude alone does not appear to increase partograph use in practice.	**Low [23, 36, 40, 41] *V low [29, 32, 42, 47, 49]
What is the impact of partograph use on clinical outcomes?	n = 6	Evidence from RCTs suggests there is no improvement in clinical outcomes when a partograph is used. Pre- and post-implementation studies suggest that use of the partograph may contribute to shorter labours, reduced sepsis, reduced postpartum haemorrhage, and improved fetal outcomes. There is evidence, although limited, to suggest that the partograph may improve outcomes in low-resource settings.	***Medium [18, 22, 56] *V low [19–21]
What is the impact of the partograph on quality of care?	n = 0	None of the included studies assessed quality of care in relation to partograph use. Data related to improved maternal outcomes post-intervention, such as fewer vaginal examinations, may indicate that women may have a better experience of labour, but there is no empirical evidence to support this.
What is the impact of partograph use on maternal satisfaction?	n = 0	No studies evaluated maternal satisfaction.
Is the partograph a useable tool?	n = 3	The modified partograph is easier for providers to use than the composite partograph and may improve outcomes.	***Medium [22, 23] **Low [3]