Acceptability of the Non-pneumatic Anti-Shock Garment (NASG) for management of obstetric hemorrhage in a rural Mexican public health system

Preliminary data on the success of the NASG in saving mothers who are suffering from obstetrical hemorrhage have been promising. However, single technologies alone are rarely adequate to reduce maternal mortality ratios (MMRs) in any significant way. Integration of the technological innovation needs to be conducted within a health care system, and the process of acceptability of the new technology must be viewed from a policy and systems perspective. During a pilot effectiveness study of the introduction of the NASG into the Mexican Institute of Social Security (IMSS) Opportunidades program, in-depth semi-structured interviews were conducted with 77 nurses, doctors, patients and family members at 12 primary health care facilities and 5 rural hospitals. Among the providers, acceptance occurred in four trajectories, owning, doubting, resisting, and rejection. Through comparison of these trajectories, the necessary conditions for enhancing acceptance within this health care system were discovered. Differences in staff training, need for interventions versus competing resources, staff turnover, and organizational structure all affected the up-take and incorporation of the NASG and the frequency of its use. While there were specific properties of the NASG that facilitated its acceptance, including simplicity of use, advantage over existing resources, and ease of observability of results; the process of how, who introduced the NASG, and to whom, variably affected its rapidity of acceptance. Findings from this qualitative study can inform future implementation processes for program mangers, health care facility directors, and maternal health policy makers who consider adding the NASG to their maternal health care system.