Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review

Table 1 Classification of barriers to and incentives for partograph use in low and middle income countries

Theme [6]	Characteristics [6]	Incentives identified in thematic analysis	Barriers identified in thematic analysis
The innovation itself	Advantages in practice	Monitoring labour	Availability
	Feasibility	Continuity of care	Graphing skills
	Credibility		Language
	Accessibility		Literacy
	Attractiveness		Many partograph versions
Individual professional	Awareness	Skilled birth attendants	Awareness
	Knowledge	Positive attitude	Knowledge
	Attitude		Skills
	Motivation to change		Commitment
	Behavioural routines		Confidence
			Negative attitude
Patient (Woman)	Knowledge	Knowledge	Late admission
	Skills
	Attitude
	Compliance
Social context	Opinion of colleagues	Leadership	Inter-professional barriers
	Culture of the network	Staff involvement	Lack of:
	Collaboration	Supervision	- Engagement
	Leadership	Monitoring	- Leadership
		Audit	- Role models
		Evaluation	- Facilitation
			- Monitoring
			- Evidence-based practice
			Retrospective documentation
Organisational context	Organisation of care processes	Supporting policy	Lack of guidelines
	Staff	Staff involvement	Poor record keeping
	Capacities	Teamwork	Shortage of equipment, clinical supplies,
	Resources		and medicines
	Structures		Workload
			Understaffing
			Frequent staff rotation
			Demoralised staff
Economic and political context	Financial arrangements	National policy	Deficiencies in service provision for maternity care
	Regulations	Medico-legal duty
	Policies

ISSN: 1471-2393