Protocol #7 - Program Evaluation of Continuous Labor Support intervention

Protocol #7 - Program Evaluation of Continuous Labor Support intervention

by Heidi Moseson -

1. Considering the protocol you are developing: identify the process and outcome indicators associated with the program and briefly describe an approach to measuring each.

At least as far as I have conceptualized the intervention thus far, the below items I think fit in the process and outcome indicator categories.

Process Indicators:

  • •All staff education workshop on L&D ward
    • oMeasure: When held? How many individuals attend? From which staff categories (nurses, OBGYNs, administrators, anesthesiologists, etc)?
    • •Follow-up survey after education workshop
    • oMeasure: response rate, response rate by staff type, understanding of material presented about doula program, as well as knowledge, understanding and intentions related to doula services
    • •Provider provision of prenatal education of patients regarding doula services
    • oMeasure: absolute number of patients provided information, percentage of patient visits where information is presented, characteristics of providers who provide this information (as well as those who don’t), characteristics of patients who are provided this information (as well as those who are not)
    • •Patient survey regarding prenatal education:
    • oMeasure: response rate, characteristics of respondents, survey measuring knowledge, understanding, and intentions related to doula services
    • •Doula recruitment:
    • oMeasure: Where are doulas recruited from? How many doulas recruited? Over what period? 
    • •Doula survey:
    • oMeasure: response rate, characteristics of respondents, survey measuring knowledge, understanding, and intentions related to doula services and how they will be implemented at the hospital 

Outcome Indicators:

  • •Utilization of Doula services
  • oMeasure: number of days doulas are available in the L&D ward in-person vs on call, number of women offered doula services, number of women accepting/utilizing doula services
  • •Labor & Delivery outcomes:
  • oMeasure: c-sections vs vaginal births in hospital by doula-assisted and non, use of instrumentation in delivery with doula-assisted births vs none, length of birth by doula vs non, use of pitocin by doula-assisted vs non, use of epidural by doula vs none, patient satisfaction with doula-assisted birth vs none

2. Define one or more “intermediate” outcome measures (reflecting changes in environment, organizational culture, systems of care, patient or public behavior, and/or clinician behaviors) that can inform you about the mechanism by which your intervention achieves its downstream effect on health inform you about the acceptability of your intervention.

Perhaps one such “intermediate” measure might be an assessment of the experience of various stakeholders (patients, providers, and doulas) as the process is being implemented. This could take the form of a survey or of in-person interviews, asking a representative sample from each group about their experiences with the implementation of the project, including concerns and successes, particularly addressing degree of cooperation/welcoming between staff and doulas, what they think is working, what they think is not working, etc. This intermediate data could be used to adjust the implementation of the program and perhaps enhance its effectiveness. It might also help identify areas of weakness that may explain a failure of the project.

Re: Protocol #7 - Program Evaluation of Continuous Labor Support intervention

by Lindsay Hampson -

Heidi - nice job.

I do think it will be key for you to identify during implementation what processes work best to both get the word out about your program and to find out what resonates most with people. It's probably going to be most helpful to learn what techniques worked and were most accepted by women in terms of being told about and accepting doula services. Can you ask some questions related to their thoughts about being provided information, how they were approached, what information they were given, etc. to find out what they liked and didn't like to help refine how you target them and what information you provide them with in the future?

Re: Protocol #7 - Program Evaluation of Continuous Labor Support intervention

by Grace -

Hi Heidi,

I was wondering if there was anyway to make the education mandatory to attend or offer something along the lines of getting credit for CEU's. I think there's a whole a buy-in process not only within the system you're working for but also for the individual providers who will be participating in the program. I wonder if the intermediate phase can involve finding out what would make the project worthwhile for the providers and refining the program based on that. I like the project overall especially because its a collaborative effort between 2 specialities.

Re: Protocol #7 - Program Evaluation of Continuous Labor Support intervention

by Ralph Gonzales -

Heidi,

This is really good.  It may be tough to get everyone to the workshop, in which case you might want to consider one-on-one meetings with specific OBGYNs and nurses that are critical to your program.  Often times, programs find “champions” to do peer-education/recruitment…

Excellent outcome measures.

Under your intermediate outcomes, I do think this will be critical for you to understand if the education and experience of the program had a positive effect on your target nurses and OBGYNs.  An attitude assessment across all eligible would be very helpful. 

Re: Protocol #7 - Program Evaluation of Continuous Labor Support intervention

by Sirina Keesara -

Hi Heidi, 

You might want to add some outcome indicators of physician's perceived importance of doulas and alternative support systems. Great work though, this list is very comprehensive!