dissemination and implementation strategies for doula support services in bayelsa state, nigeria: a quantitative cross-sectional survey

Background: critical shortages of skilled birth attendants due to brain drain have compromised the delivery of respectful, person-centred maternity care in nigeria. integrating doula support services has been proposed to complement midwifery care and bridge this gap. this study quantified stakeholders' views on effective approaches for disseminating and implementing these services in bayelsa state.objectives: this cross-sectional study aimed to: 1) assess stakeholders' knowledge of doula services, 2) identify their preferred dissemination and implementation strategies, and 3) examine associations between knowledge and demographic/professional characteristics.methods: a descriptive cross-sectional census survey was conducted among 101 maternal health stakeholders (midwives and nursing directors) from two tertiary hospitals and two health governance bodies in bayelsa state. data were collected using a validated, researcher-structured questionnaire. the analyses included descriptive statistics and inferential statistics (chi-square test and odds ratios).results: all 101 participants (100%) correctly defined a doula's role. over 97% agreed on community-based outreach strategies using health talks and tailored messaging. for implementation, there was unanimous (100%) agreement on the need for government policy, standardized training, and clear referral pathways. midwives were the preferred clinical leaders (92.1%). overall, 92.1% of stakeholders had good knowledge, which was significantly associated with more years of work experience (or: 1.13; p=0.045).conclusion: stakeholders strongly endorse a scalable implementation model featuring policy integration, midwife-led coordination, culturally adapted community dissemination, and a structured framework for training, referral, and supervision. this model presents a viable strategy to mitigate workforce shortages and institutionalise respectful maternity care in bayelsa state.