Introduction
PTB, prematurity
PRETERM BIRTH, COMPLICATIONS
Preterm birth (PTB, birth at < 37 weeks’ gestation) remains a crucial issue in improving outcomes and quality of maternal, newborn and child health care. One in ten babies worldwide are born too soon and over a million die from complications associated to their prematurity [Complex interventions, such as continuity models and other maternity care packages, are composed of multiple and different interacting components, and non-linear causal pathways [Multiple guides and tools are available to integrate implementation science concepts and methods to facilitate the identification and evaluation of factors likely to affect implementation efforts and evaluate implementation outcomes alongside the clinical impact [The It was hypothesized that initiation of these treatments would occur earlier and at a more appropriate time in the intervention group, as the POPPIE model would improve quality of care by providing a trusted safety net with midwives ensuring better care coordination, referral, and access to additional services [We report the evaluation of the implementation of the POPPIE model, describe the local context in which it was delivered, the mechanisms of impact by which the delivered model may produce change, and integrate results to determine whether the effect of POPPIE on the primary outcome in our setting could be explained. Specific objectives included:Implementation outcomes: to evaluate the perceived fit of POPPIE to address local needs (appropriateness) and intention to try its use (adoption); to determine whether POPPIE could be successfully carried out within this clinical setting (feasibility); to evaluate satisfaction among women, healthcare professionals and other key stakeholders with various aspects of the intervention (acceptability); to evaluate whether the intervention was implemented as outlined in the protocol and/or whether adaptations were made (fidelity); and to evaluate how well the intervention was integrated within the maternity system (penetration) and the extent to which it was maintained over time (sustainability)Context: to describe contextual factors which impact upon’ implementation efforts.Mechanisms: to explore if and how the intervention impacted on maternity care in this setting and identify possible reasons for this.Inter-relationships: to explore relationships between core implementation and process outcomes and the primary outcome.