Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design

Figures & data

Figure 1. Direct obstetric cause of maternal mortality.

Source: UNICEF Data 2023 [3]

Table 1. The various types of hypertensive disorders of pregnancy (HDP).

Type of HDP	Time of diagnosis	Features
Chronic hypertension	<20-week gestation	Elevated blood pressure: systolic/diastolic >140/90 mmHg
Gestational hypertension	>20-week gestation	Elevated blood pressure: systolic/diastolic >140/90 mmHg
Preeclampsia	>20-week gestation	Elevated blood pressure with*: proteinuria and/or maternal acute kidney injury, liver dysfunction, neurological features, hemolysis, or thrombocytopenia with/or without HELLP syndrome, or fetal growth restriction
Eclampsia	>20-week gestation	Same as preeclampsia, with the addition of fits

*Current ISSHP definition also allows for the diagnosis of preeclampsia in the absence of hypertension, but with one of the organ damage symptoms.

Source: ISSHP, 2018 [10].

Figure 2. WHO framework for improving quality of maternal and newborn care in health facilities.

Source: WHO 2016 [36]

Table 2. Overview of knowledge gaps, methodological approach, and relevant stakeholders participating.

Knowledge gaps to be addressed: research objectives and questions	Methods/tools	Stakeholders involved
1. Assess barriers to and facilitators of meaningful participation in co-creation. 1.1. How might stakeholders’ knowledge or skills gaps; motivation; relationships, trust and power-dynamics become barriers to meaningful collaboration and co-creation? 1.2. How can we address identified barriers to, and strengthen facilitators of, co-creation and involve all stakeholders in a meaningful way?	● Literature review ● FGDs, including participatory methods: problem trees; ● Semi-structured interviews ● Observations during a) APEC webinars and b) co-creation activities	● Health providers (obstetricians; midwives) ● Facility managers ● Survivors ● Male partners ● Relatives
2. Assess understandings, preferences and suitable forms of a) risk communication and b) shared decision-making 2.1 How are HDP associated risks currently communicated by professionals and responded to by clients, spouses, or relatives during consultations? 2.2. What are providers’ & women’s preferences regarding risk communication related to HDP? 2.3. How are treatment-related decisions currently communicated by professionals and responded to by clients, spouses, or relatives during consultations? 2.4. What do different stakeholders understand by, and associate with, the term SDM? 2.5. Are alternative terms more appropriate (e.g. collaboration; patient-centered care; effective communication)? 2.6. What are providers’ & women’s preferences regarding decision-making concerning the treatment of women with HDP? 2.7. What modes of involving women in clinical decision- making do health providers and women consider appropriate and relevant? 2.8. What, if any, might be the unintended consequences of shared decision-making between providers and women?	● Literature review ● FGDs ● Semi-structured interviews ● Ethnographic observations of care interactions ● Structured conversations ● Conversation analysis: recordings of consultations with women with HDP (pre and post labor, not during labor) ● Embedding of questions in and observations of APECGH webinars.	● Health providers (obstetricians; midwives) ● Health managers ● Survivors ● Women with HDP ● Male partners ● Relatives ● Policy makers
3. Assess personal, interpersonal and system barriers to, and facilitators of SDM. 3.2. What barriers may affect SDM? 3.1. How might these barriers affect SDM? 3.3. How might knowledge or skill gaps, relational aspects (power-dynamics, trust between different stakeholders) or health system factors constitute barriers or facilitators to shared decision-making? 3.4. What, if any, are available guidelines regarding SDM or effective communication, according to protocols and training manuals in Ghana? 3.5. To what extent do providers know of guidelines and have been trained in, regarding SDM and effective communication? 3.6. How can we address barriers to SDM? 3.7. How can we strengthen facilitators of SDM or other forms of patient centred care deemed appropriate to the local context?	● FGDs ● Semi-structured interviews ● Observations during a) APEC-Ghana webinars and b) co-creation FGDs/activities ● Structured conversations ● Ethnographic observations of care interactions ● Conversation analysis: recordings of consultations with women with HDP (pre and post labor, not during labor) ● Document review (for 3.4, 3.5).	● Health providers (obstetricians; midwives) ● Facility managers ● Survivors ● Women with HDP ● Male partners ● Relatives

Figure 3. Visualization of proposed tool components.

Figure 4. Overview of the SPOT-tool co-creation phases.

Phases 2–4 are iterative

UNICEF. UNICEF data: maternal mortality. 2023. [cited 2023 Sep 4]. https://data.unicef.org/topic/maternal-health/maternal-mortality/

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