Models of Antenatal Care: a pilot study to explore a new quality care framework

Systematic reviews (e.g. Sandall et al. 2015) have demonstrated a link between midwifery-led continuity of care models and improved Clinical, Psychosocial and Organisational (CPO) outcomes, including preterm birth and breastfeeding rates. However, the underlying causal mechanisms within these models are not understood, and trial reports rarely detail all the relevant contextual factors for the intervention and control groups. This pilot study will test the use of focus groups with service users and providers across NHS Tayside and NHS Fife in an exploration of their perceptions of the antenatal care model with which they are familiar. The focus groups will use as their starting point the Quality Maternal and Newborn Care (QMNC) Framework published in The Lancet Series on Midwifery. While this Framework for quality care is well-evidenced and peer reviewed, it has yet to be determined how service users and providers in different care models understand or experience the components and characteristics of care which the Framework describes. These pilot focus groups are therefore needed to explore how service users and service providers perceive or understand how the characteristics of care specified in the Framework apply to the model of care with which they are most familiar. Analysing these interviews will help us to understand better how to design largerscale fieldwork that will result in development of a care model evaluation toolkit. This will allow us, other researchers, the NHS and policy-makers to assess service provision across a range of settings, models of care and regions. This pilot study will be conducted in three varying care model settings within Tayside and Fife: in-hospital continuity midwifery; out-of-hospital continuity midwifery; ‘standard’ care with no or little prescribed continuity element (which in practice often means in-hospital obstetric-led), and will be guided by Patient and Public Involvement. We emphasise that while settings and care models overlap, they are not synonymous. ‘Continuity’ is not restricted to midwifery care; and ‘standard’ care varies according to local circumstances. Due to ethical concerns, not all supporting data can be made openly available. A minimal dataset that is comprised of a transcript of a focus group is held in the repository and further information about the restrictions on data access are available from the University of Dundee Institutional Repository - email [email protected] The study protocol is available under a CC-BY licence

Transforming the Quality Maternal Newborn Care Framework into an index (QMNCFi) to measure the quality of maternity care

BACKGROUND: The Quality Maternal and Newborn Care (QMNC) Framework describes the care that childbearing women and newborn infants need in all settings. It comprises five components and was designed for use in planning, workforce development, and resource allocation, aimed at improving the quality and cost effectiveness of maternal and newborn care globally. The purpose of this paper is to describe the first phase of a project designed to transform the Framework into a quantitative tool for service user assessment of the quality of maternity care. METHODS: Each component of the original Framework content was developed into a draft service user questionnaire and distributed to an expert panel, drawn from a range of low-, middle-, and high-resource countries. The panel consisted of five Framework authors, nine midwife researchers, six midwives, and five service user (consumer) advocates. Two rounds of discussion and revision were undertaken with the expert panel who commented on the importance, relevance and clarity of questions, and then on their necessity, wording, and order. A third round involved two experts in survey design. RESULTS: Following 24 responses in the first round, the questions were refined and returned to the panel. After incorporating the second-round comments from 16 experts, the survey was then sent to two experts in questionnaire design and construction. Face validity was affirmed through this consultative process. CONCLUSIONS: Despite Covid-19 pandemic-related restrictions, this robust iterative consultative process with an international expert panel has resulted in the prototype QMNC Framework index (QMNCFi)-a questionnaire designed for use in diverse settings to assess the quality of maternity care. The QMNCFi's psychometric properties are now being tested in an international online survey

The feasibility and acceptability of using the Mother-Generated Index (MGI) as a Patient Reported Outcome Measure in a randomised controlled trial of maternity care

Background: Using patient-reported outcome measures (PROMs) to assess Quality of Life (QoL) is well established, but commonly-used PROM item-sets do not necessarily capture what all respondents consider important. Measuring complex constructs is particularly difficult in randomised controlled trials (RCTs). The Mother-Generated Index (MGI) is a validated antenatal and postnatal QoL instrument in which the variables and scores are completely respondent-driven. This paper reports on the feasibility and acceptability of the MGI in an RCT, and compares the resulting variables and QoL scores with more commonly used instruments. Methods: The single-page MGI was included at the end of a ten page questionnaire pack and posted to the RCT participants at baseline (28-32 weeks' gestation) and follow-up (six weeks postnatal). Feasibility and acceptability were assessed by ease of administration, data entry and completion rates. Variables cited by women were analysed thematically. MGI QoL scores were compared with outcomes from the EQ-5D-3 L; Edinburgh Postnatal Depression Scale; Satisfaction With Life Scale; and State Trait Anxiety Inventory. Results: Six hundred and seventy eight pregnant women returned the pack at baseline; 668 completed the MGI (98.5 %); 383/400 returns at follow up included a completed MGI (95.7 %). Quantitative data were scanned into SPSS using a standard data scanning system, and were largely error-free; qualitative data were entered manually. The variables recorded by participants on the MGI forms incorporated many of those in the comparison instruments, and other outcomes commonly used in intrapartum trials, but they also revealed a wider range of issues affecting their quality of life. These included financial and work-related worries; moving house; and concerns over family illness and pets. The MGI scores demonstrated low-to-moderate correlation with other tools (all r values p &lt;.01). Conclusions: Without face-to-face explanation and at the end of a long questionnaire, the MGI was feasible to use, and acceptable to RCT participants. It allowed individual participants to include issues that were important to them, but which are not well captured by existing tools. The MGI unites the explanatory power of qualitative research with the comparative power of quantitative designs, is inexpensive to administer, and requires minimal linguistic and conceptual translation. Trial registration: ISRCTN27575146 (date assigned 23 March 2011)</p

Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework

© 2019 Problem: Midwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow. Background: It is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services. Aim: We aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings. Methods: Data were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework. Findings: Good quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes. Discussion: Midwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Organisations have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the framework. Conclusion: The QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care