eprintid: 10162173 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/16/21/73 datestamp: 2022-12-22 10:07:47 lastmod: 2022-12-22 10:07:47 status_changed: 2022-12-22 10:07:47 type: article metadata_visibility: show sword_depositor: 699 creators_name: Zahroh, Rana Islamiah creators_name: Kneale, Dylan creators_name: Sutcliffe, Katy creators_name: Vazquez Corona, Martha creators_name: Opiyo, Newton creators_name: Homer, Caroline SE creators_name: Betrán, Ana Pilar creators_name: Bohren, Meghan A title: Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features ispublished: pub divisions: UCL divisions: B16 divisions: B14 divisions: J81 keywords: Maternal health, Caesarean section, Qualitative comparative analysis, Complex intervention, Intervention implementation note: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. abstract: BACKGROUND: Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population-level have limited benefits for women and babies. Many interventions targeting healthcare providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting healthcare providers. METHODS: We used Qualitative Comparative Analysis (QCA) to identify if certain combination of important intervention features (e.g. type of intervention, contextual characteristics, and how the intervention was delivered) are associated with a successful intervention as reflected in a reduction of CS. We included 21 intervention studies targeting healthcare providers to reduce CS, comprising of 34 papers reporting on these interventions. To develop potential theories driving intervention success, we used existing published qualitative evidence syntheses on healthcare providers' perspectives and experiences of interventions targeted at them to reduce CS. RESULTS: We identified five important components that trigger successful interventions targeting healthcare providers: 1) training to improve providers' knowledge and skills, 2) active dissemination of CS indications, 3) actionable recommendations, 4) multidisciplinary collaboration, and 5) providers' willingness to change. Importantly, when one or more of these components are absent, dictated nature of intervention, where providers are enforced to adhere to the intervention, is needed to prompt successful interventions. Unsuccessful interventions were characterised by the absence of these components. CONCLUSION: We identified five important intervention components and combinations of intervention components which can lead to successful interventions targeting healthcare providers to optimise CS use. Health facility managers, researchers, and policy-makers aiming to improve providers' clinical decision making and reduce CS may consider including the identified components to optimise benefits. date: 2022-12-14 date_type: published publisher: Springer Science and Business Media LLC official_url: https://doi.org/10.1186/s12913-022-08783-9 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1996840 doi: 10.1186/s12913-022-08783-9 pii: 10.1186/s12913-022-08783-9 lyricists_name: Kneale, Dylan lyricists_name: Sutcliffe, Katy lyricists_id: DKNEA72 lyricists_id: KSUTC11 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: BMC Health Services Research volume: 22 article_number: 1526 event_location: England citation: Zahroh, Rana Islamiah; Kneale, Dylan; Sutcliffe, Katy; Vazquez Corona, Martha; Opiyo, Newton; Homer, Caroline SE; Betrán, Ana Pilar; Zahroh, Rana Islamiah; Kneale, Dylan; Sutcliffe, Katy; Vazquez Corona, Martha; Opiyo, Newton; Homer, Caroline SE; Betrán, Ana Pilar; Bohren, Meghan A; - view fewer <#> (2022) Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features. BMC Health Services Research , 22 , Article 1526. 10.1186/s12913-022-08783-9 <https://doi.org/10.1186/s12913-022-08783-9>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10162173/1/s12913-022-08783-9.pdf