Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers
Authors: Hamm Rebecca F. , Moniz Michelle H. , Wahid Inaya , Breman Rachel Blankstein , Callaghan-Koru Jennifer A. ,   Implementation Science for Maternal Health National Working Group, Allyse Megan , Bennet Ian , Bingham Debra , Blackman Kacie , Brewer Sarah , Cochran Jerry , Creanga Andreea , Cunningham Shayna , Daley Ellen , DeSisto Carla , Farahi Narges , Franck Linda , Goff Sarah , Griner Stacey , Haider Sadia , Hansen Anna , Harden Samantha , Harper Kimberly , Hofler Lisa , Horvath Sarah , Ickovics Jeanette , Johnson Jennifer , Kaplan Heather , Kroelinger Charlan , Larson Elysia , Le Huynh-Nhu , Lee Henry , McAlearney Ann , McCarthy Danielle , McCloskey Lois , Meghea Cristian , Miller Emily , Mollard Elizabeth , Moore Simas Tiffany , Moses-Kolko Eydie , Novick Gina , Palmer Molina Abigail , Patel Divya , Qasba Neena , Raghuraman Nandini , Romano Amy , Rosenstein Melissa , Sheth Sangini , Simon Melissa , Smith Sharla , Srinivas Sindhu , Sufrin Carolyn , Tabak Rachel , Thompson Erika , Vamos Cheryl , Walker Daniel , Wallace Jackie , Xiao Jin , Yee Lynn , Zera Chloe , Zite Nikki 
Published: July 2023

Abstract
Background
Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA.

Methods
This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures.

Results
Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research.

Conclusions
Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area.