This mixed-methods study aims to:

• Understand the awardees' experiences in building and maintaining cohesive networks to support maternal care for the Rural Maternity and Obstetrics Management Strategies (RMOMS) population
• Explore the challenges and facilitators they are encountering in network building and rural maternal care services improvements
• Conduct a program sustainability assessment

The study will provide valuable evidence into improving network-building strategies, enhancing maternal care services, optimizing network-building support, and fostering sustainable solutions that continue to serve rural maternal populations. This study will collect data using a mixed-methods approach combining interviews, site visits, and quantitative survey research methods. In-depth interviews will be conducted by two moderators and a note-taker with a purposive sample of awardees who have been involved in network-building initiatives for maternal care in rural areas.

We will contact the three awardees to schedule team interviews, provide program assessment surveys for each team to fill out, and schedule site interviews (expected 3-4 interviews per site) to understand the routine strategic planning or community activities. The interviews will be conducted using an open-ended semi-structured model informed by the research questions and domains stated above. Program assessment tools in a Likert's scale survey form will be administered to each of the three awardee teams to quantitatively (descriptive statistics) assess the program's capacity building experience and capacity for sustainability across a range of specific organizational and contextual factors. We will describe network-building efforts and the Federal Office of Rural Health Policy's support on these capacity domains. Each participant will receive an honorarium upon the competition of the interview and survey. All interviews will be transcribed followed by qualitative coding and analysis by two independent analysts with qualitative training. The analysis will be conducted parallel to the data collection. The analysis will guide the data saturation and theory generation.

The research team will identify broad content areas and themes emerging from discussions with relevant stakeholders (thematic analysis). We will provide quotes and detailed descriptions of the context and participants in any disseminated materials. Quantitative data will be analyzed using descriptive statistics (e.g., frequency, proportions) to present the level of capacity across internal/external support, resource stability, community/network partnership, maternity care or organizational capacity, continuous program evaluation, program adaptation, communication/coordination across stakeholders, and strategic planning for rural maternity care in the serving areas.