A knowledge translation toolkit for maternal health implementation planning in low- and middle-income countries: development and pilot evaluation in two countries

Background Knowledge translation (KT) approaches have been advocated to increase uptake of evidence to improve maternal health outcomes in low- and middle-income countries (LMICs). However, their use is limited by lack of KT capacity and limited applicability of many existing KT tools to the unique challenges of LMIC health settings. We developed and evaluated a toolkit designed for use by non-experts and tailored to support implementation planning in LMICs. Method Based on our prior research which identified common implementation barriers across five LMICs, a literature review and a qualitative study with women and families in two LMICs, we developed a preliminary item list. Through consultation with our international partners, the item list was refined, a draft toolkit developed and usability tested. Pilot evaluation of the toolkit employed observation and focus groups with participants at implementation planning meetings conducted in Argentina and Ghana, focused on locally identified evidence-based maternal health implementation priorities. Results 31 interested parties participated, 10 in Argentina and 21 in Ghana, representing a range of roles relevant to implementation in the local contexts including providers, health educators, policy/decision makers, researchers and patients/patient representatives. Participants reported a number of benefits to the content and organisation of both the toolkit and meeting format, which they noted encouraged open exchange of perspectives and experiences, and comprehensive consideration and discussion of barriers and facilitators (BFs) to implementation in their context. Minor changes to the instructions and wording of a few BFs were suggested and incorporated. Conclusion The toolkit provides a resource to support LMIC maternal health implementers by offering a structured approach to assessment and ranking of BFs to implementation and a guide to mapping BFs to evidence-based implementation strategies. Further evaluation across a wider range of health topics and LMICs and in low-resource contexts in high-income countries is needed.