Developing A Conceptual Framework for Effective Dissemination and Implementation of Doula Support Service in Bayelsa State, Nigeria

Abstract

Background: Maternal morbidity and mortality in Bayelsa State are worsened by gaps in culturally congruent companionship, communication, and psychosocial support across pregnancy, labour, and the postpartum period. Continuous, non-clinical support can improve women’s experiences and help mitigate the “three delays” in seeking, reaching, and receiving timely care. Objective: To develop a conceptual framework to guide effective dissemination and implementation of doula support services in Bayelsa State, Nigeria. Methods: Phase Two synthesised Phase One qualitative and quantitative findings. Concepts were classified using Dickoff et al.’s survey-list elements (agent, recipient, context, dynamics, process, and terminus) and then structured and described using Chinn and Kramer’s theory-generative steps. Results: Agents comprised the State Ministry of Health, facility leadership, nurses, midwives, obstetricians, doula trainers/mentors, media, civil society organisations, and faith/women’s groups; recipients included pregnant/postpartum women, partners/families, and community influencers. The process specified sequential actions: policy development and adoption, professional endorsement, training and certification, facility integration, community dissemination, piloting with iterative scale-up, monitoring, and sustainability. Dynamics emphasised financing and logistics, government commitment, partnerships, communication, and cultural tailoring; intended outcomes were awareness, acceptability, adoption, fidelity, reduced delays, and improved maternal–neonatal indices. Long-term evaluation is essential. Conclusion: The framework offers a pragmatic pathway for institutionalising doula services through coordinated, stakeholder-driven action and feedback-based improvement. Midwives should lead role clarification, supervise doulas, integrate supportive-care documentation into routine maternity workflows, and drive monitoring and quality-improvement cycles to embed respectful, woman-centred care at scale.