BARRIERS AND FACILITATORS TO NURSE-LED MATERNAL HEALTH INTERVENTIONS IN RURAL AND URBAN HEALTHCARE SETTINGS

Abstract

Nurse-led maternal health interventions have become increasingly important in addressing workforce shortages, improving antenatal care continuity, and strengthening maternal health service delivery across diverse healthcare settings. This study examined the barriers and facilitators influencing the implementation of nurse-led maternal health interventions in rural and urban healthcare facilities, with particular attention to the role of digital health tools. A convergent mixed-methods design was employed, integrating retrospective clinical performance data from 12 healthcare facilities with qualitative insights from 40 nurses and 10 maternal health administrators. Quantitative indicators included antenatal care attendance, follow-up completion, digital tool utilization, postnatal contact, and referral documentation completeness. Qualitative data were analyzed thematically to identify contextual, organizational, and technological factors shaping implementation outcomes. The findings revealed that urban facilities performed better across all measured indicators, particularly in digital tool utilization and referral documentation, largely due to stronger infrastructure and institutional support. In contrast, rural facilities experienced greater challenges related to connectivity instability, limited technical resources, staff shortages, and patient access barriers. Training adequacy, managerial support, perceived ease of use, low-bandwidth tools, and nurse-patient communication emerged as key facilitators of successful adoption. However, workload pressure and poor system integration reduced nurses’ willingness and ability to sustain digital practices. Overall, the study demonstrates that nurse-led maternal health interventions can improve service continuity when supported by context-sensitive digital design, practical training, workflow integration, and sustained institutional investment. The findings highlight the need for rural-specific implementation strategies that address infrastructural inequities while ensuring that digital tools reduce, rather than increase, the burden on frontline nurses.