Bridging the Human-Machine Gap: Humanizing CTGs with Global Majority Women's Voices-  An e-PPIE Co-Production Project

Introduction. Research on women's perspectives regarding cardiotocography (CTG) during labour is limited, particularly among women from the Global Majority, who are often underrepresented in clinical research. This lack of data perpetuates inequalities in maternal health and research. To examine the acceptability of CTG-driven digital tools and identify access disparities, a Patient and Public Involvement and Engagement (PPIE) project was conducted with women as co-researchers. Drawing from their negative maternity care experiences, the co-researchers emphasised the importance of humanizing CTG interactions rather than focusing solely on digital solutions for improving outcomes. This need was then transformed into a workshop. Aim and methods. This project aimed to explore how to enhance the current provision of CTG care for women from the Global Majority. One online PPIE workshop with four co-researchers took place and two co-researchers contributed offline. The workshop included a live artist and two research-facilitators. Findings. Co-researchers identified approaches to humanize the CTG experience by improving communication and consent around EFM, providing evidence to support women’s decision-making about EFM, and delivering EFM information in the antenatal period. Conclusion. Co-researchers identified areas of improvement and future research questions to close the current human-machine gap between women, clinicians and CTG technology. These areas included the need for improving trust, communication and consent by providing unbiased and evidence-based information to support women’s decision-making about CTGs. Equitable and accessible PPIE is instrumental in addressing health and research disparities and improving perinatal health.