Optimizing obstetric life support training in rural healthcare settings in New England: protocol for a multisite prospective study

Maternal mortality rates in the United States have steadily risen over the past two decades, despite being largely preventable with timely and appropriate care. Obstetric Life Support (OBLS) is an evidence-based, interdisciplinary simulation curriculum designed to train prehospital and hospital-based healthcare workers (HCWs) in recognizing, preventing, and managing maternal medical emergencies. However, its implementation has primarily been limited to high-resource settings with access to optimal training infrastructure. Rural settings often face unique challenges that hinder the translation of evidence-based health practices. This manuscript outlines a protocol to identify barriers and facilitators to OBLS implementation and develop and evaluate an adapted curriculum tailored to rural communities in New England. This study represents a collaboration between the University of Connecticut Health, the New England Rural Health Association, and the Dartmouth Health Center for Rural Emergency Services and Trauma (CREST). Surveys and focus groups will be conducted with prehospital and hospital-based administrators and HCWs in rural settings to explore elements of the consolidated framework for implementation research that may influence implementation outcomes. Using an implementation mapping process, the OBLS curriculum will be adapted for rural contexts. The revised curriculum will be evaluated at four rural-serving sites (two hospital-based and two prehospital-based) in New England. Participants will complete surveys at baseline, immediately post-course, and at 6- and 12-month intervals to assess the impact of the training on their knowledge, self-efficacy, and clinical skills to managing maternal medical emergencies. Equitable scale-up of OBLS necessitates an implementation plan that addresses the unique contextual challenges, resource limitations, and delivery mechanisms for rural healthcare settings. This study aims to create an ‘implementation roadmap’ to guide healthcare institutions in rural and other low-resource healthcare settings, where education on maternal medical emergencies is urgently needed. Findings on knowledge and skill retention will inform strategies for targeted refresher courses, helping HCWs retain critical skills and maintain readiness to manage high-stakes maternal medical emergencies over time.