Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings. Conclusions The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
Q6 :Please check whether the formatting given in table 3 and its footnotes are correct.Response: Resolved Q7 : The disclosure statement has been inserted. Please correct if this is inaccurate. Response: Resolved Q8 : The CrossRef database (www.crossref.org/) has been used to validate the references. Mismatches between the original manuscript and CrossRef are tracked in red font. Please provide a revision if the change is incorrect. Do not comment on correct changes. Response: Resolved Q9 : Please provide missing page range for reference "[16]" references list entry. Response: No page range available Q10 : Please provide missing page range for reference "[21]" references list entry. Response: Resolved Q11 : Please provide missing page range for reference "[29]" references list entry. Response: Resolved Q12 : Please provide missing page range and editors name for reference "[42]" references list entry. Response: Resolved Q13 : Please provide missing volume number for reference "[83]" references list entry. Response: Resolved Q14 : Please provide missing page range for reference "[92]" references list entry.
Background: For women with straightforward pregnancies midwifery units (MUs) are associated with improved maternal outcomes and experiences, similar neonatal outcomes, and lower costs than obstetric units. There is growing interest and promotion of MUs and midwifery-led care among European health policymakers and healthcare systems, and units are being developed and opened in countries for the first time or are increasing in number. To support this implementation, it is crucial that practice guidelines and improvement frameworks are in place, in order to ensure that MUs are and remain well-functioning.<br/>Aims and objectives: This project focused on the stakeholder engagement and collaboration with MUs to implement the Midwifery Unit Self-Assessment (MUSA) Tool in European MUs. A rapid participatory appraisal was conducted with midwives and stakeholders from European MUs to explore the clarity and usability of the tool, to understand how it helps MUs identifying areas for further improvement, and to identify the degree of support maternity services need in this process.<br/>Key conclusions: Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders. A fresh-eye view from the external facilitators on dynamics within the MU and its relationship with the obstetric unit was highly valued. However, micro-, meso- and macro-levels of organisational change and their associated stakeholders need to be further represented in the MUSA-Tool. The improvement plans generated from it should also reflect these micro-, meso- and macro-level considerations in order to identify the key actors for further implementation and integration of MUs into European health services.<br/><br/>Key messages<br/>Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders.<br/><br/>A fresh-eye view from the external facilitators were highly valued by stakeholders.<br/><br/>Micro-meso-macro levels of change need to be further represented in the MUSA-Tool.<br/><br/>The high impact actions need to reflect the micro-meso-macro levels to identify the correct players.
Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effectiveness option. However, they still do not represent the mainstream option of maternity care in many countries (1, 2). Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines (3). Included articles were appraised using the CASP checklist (4). A meta-synthesis approach to analysis was used (5). No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: drivers to open the new MUs and barriers or facilitators to the MU implementation. The latter category included eight key themes: “culture and perceptions”, “healthcare system”, “midwives’ identity and role”, “knowledge, skills and training”, “leadership”, “collaborative approach”, “integration” and “environment”. A logic model was created to explain the role of each during the implementation process. Conclusions the studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
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