Table 4.

Barriers to measuring the vital signs and using the VSA and actions made prior to the main trial

Issue from Feasibility study	Supporting quotes from Interviews and Focus Group	Changes required after feasibility study
Understanding of yellow light with down arrow	“When the pregnant woman comes to us she is well and it shows yellow down (laughs); in that case how to interpret?” Staff Nurse, India	- Training materials updated to explain the reason for each colour light. - Guidance updated to place greater emphasis on how to assess the woman to decide if further action or referral is required.
Problems with charging the VSA	“… some workers say that the battery life is good but I have to charge it for daily. If I have to go for BP check-up today I have to charge it first.” Staff Nurse, India	- Interactive training session developed which incorporates guidance on charging and accountability for charging. - Including explanation that more than 100 readings can be taken even when the battery low sign is showing and overcharging will damage the battery.
Provision of Charger	“the package should include the charger rather than USB cable only so that we can charge it easily” Staff Nurse, Zimbabwe	Chargers provided in addition to the cable that comes as standard in the package.
High staff turnover / incapacity to train all staff at once	“Initially, we faced difficulty. There were nurses using it during the night shift and they were not trained.” Staff Nurse, Bishoftu	Designated CRADLE Champions in each facility identified to provide ongoing local training and support for CRADLE VSA
Unsupportive seniors	“Recently during an ANC clinic he inquired which device we are using; we said “we are using the CRADLE device given by the research unit” then he said “oh… it shows yellow down to all pregnant women, so better do not use it”.” SN, India	- Designated CRADLE Champions identified to provide ongoing local training and support for CRADLE VSA - Engage Local Opinion leaders prior to implementation
Need for equipment	“…no BP machines at all, the one we had was no longer working.” Staff Nurse, Zimbabwe	Ensure adequate supply of VSA available