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dc.rights.licenseAttribution-NonCommercial 4.0 International (CC BY-NC 4.0)
dc.contributor.authorUwamahoro, Nadege Sandrine
dc.contributor.authorMcRae, Daphne
dc.contributor.authorZibrowski, Elaine
dc.contributor.authorVictor-Uadiale, Ify
dc.contributor.authorGilmore, Brynne
dc.contributor.authorBergen, Nicole
dc.contributor.authorMuhajarine, Nazeem
dc.identifierdoi: 10.1136/bmjgh-2022-009605
dc.identifier.citationUwamahoro, N.S., McRae, D., Zibrowski, E., Victor-Uadiale, I., Gilmore, B., Bergen, N. and Muhajarine, N. (2022) ‘Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis’, BMJ Global Health, 7(9), p. e009605. Available at:
dc.descriptionFrom BMJ via Jisc Publications Router
dc.descriptionHistory: received 2022-05-13, ppub 2022-09, accepted 2022-09-01, epub 2022-09-30
dc.descriptionPeer reviewed: True
dc.descriptionAcknowledgements: We gratefully acknowledge members of the advisory group including Anayda Portela, Denise Kouri, Jessie Forsyth, João Paulo Souza and Tami Waldron. We also extend sincere thanks to the 12 MWH implementers and policy makers who were interviewed during the PT refinement process, including, Abebe Mamo G/tsadik, Bwalya Misheck, Chipo Chimamise, Cristalina Mahumane, Esther Ngaru, Faith Akovi Cooper, Fernanda Andre, Gebeyehu Bulcha and Thandiwe Ngoma.
dc.descriptionPublication status: Published
dc.descriptionFunder: University of Saskatchewan; FundRef:
dc.descriptionFunder: Mozambique-Canada Maternal Health Project; Grant(s): D-002085
dc.descriptionIfeyinwa Victor-Uadiale - ORCID: 0000-0003-1580-1807
dc.description.abstractIntroduction: Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods: A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results: A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions: Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number: CRD42020173595.
dc.publisherBMJ Publishing Group
dc.rightsLicence for this article starting on 2022-09-30:
dc.rightsEmbargo: ends 2022-09-30
dc.rights© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
dc.sourceeissn: 2059-7908
dc.subjectOriginal research
dc.subjectMaternal health
dc.subjectOther study design
dc.subjectPrevention strategies
dc.subjectHealth services research
dc.titleUnderstanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis
refterms.depositExceptionGold OA
qmu.authorVictor-Uadiale, Ify

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