**6. Autoethnography and Delphi technique**

The recommendations discussed below are contextualized and targeted towards Nigerian women to help them actively engage in behaviors to mitigate the effects of climate change on maternal health outcomes. The recommendation from this formative report builds upon two key approaches: autoethnography and an adaptation of the Delphi technique.

The autoethnography conducted explored the major sociocultural perspectives of women in Nigeria and the researcher's perspective about climate change and health [59]. Through the ethnography, (a) there was an examination of the women's ways of speaking and relating about the changes in their immediate environment; (b) there was a core evaluation of the investigative use of space and place as it relates to climate events; (c) the researcher being part of the culture and possessing the same cultural identity was able to use personal experience as data to describe, analyze, and understand the women's sociocultural nuanced experiences [59].

Building on the existing autoethnography, this report employed the Delphi technique—a group facilitating technique that seeks to obtain consensus on the opinions of experts or individuals knowledgeable on the subject through a series of interviews [60]. The Delphi technique is a multistage process designed to combine [61] the different expert opinions into a consensus to best understand a problem, seek solutions, educate, and make informed recommendations to improve health outcomes. When there is limited or conflicting evidence, it is often used to develop evidence-based design recommendations and considerations for healthcare-built environments [62]. It has also been extensively used to generate many indicators relevant to health behaviors in communicating public health issues [63].

For this formative report, experts were purposefully selected—convenience sampling—to apply their knowledge to the existing research discourse on climate change and its effects on maternal/prenatal health outcomes (topical interview). These experts included obstetrician-gynecologists in Nigeria.

Experts were interviewed to explore their various opinions. They were asked three core questions; (a) what do you think women, especially pregnant women, need to know about the changing climate? (b) how do you think women protect themselves and their developing babies from the effects of climate change—rising temperatures; (c) how do you think women protect themselves and their developing babies from the effects of climate change—air pollution.

The experts provided nuanced contextual information related to the sociocultural and economic effects and how it is intertwined with climate effects on health outcomes. These experts' communication adequately informed the recommendations in this report.
