Adapting the Quality Maternal and Newborn Care (QMNC) Framework to evaluate models of antenatal care: A pilot study

Abstract

BackgroundRecent evidence indicates that continuity models of maternity care result in improved clinical and psychosocial outcomes, but their causal mechanisms are poorly understood. The recent Lancet Series on Midwifery’s Quality Maternal and Newborn Care Framework describes five components of quality care and their associated characteristics. As an initial step in developing this Framework into an evaluation toolkit, we transformed its components and characteristics into a topic guide to assess stakeholder perceptions and experiences of care provided and received. The main purpose of this study was to assess the feasibility of this process.MethodsWe conducted twelve focus groups in two Scottish health board areas with 13 pregnant women, 18 new mothers, 26 midwives and 12 obstetricians who had experience of a range of different models of maternity care. Transcripts were analysed using a six-phase approach of thematic analysis. We mapped the identified themes and sub-themes back to the Framework.ResultsThe emerging themes and sub-themes demonstrated the feasibility of using the QMNC framework as a data collection tool, and as a lens for analysing the data. Of the four emerging themes, only Organisation Culture / Work Structure’ mapped directly to a single Framework component. The others—‘Relationships’; ‘Information and support’; and ‘Uncertainty’–mapped to between two and five components, illustrating the interconnectedness of the Framework’s components. Some negative sub-themes mirrored positive Framework characteristics of care. Some re-phrasing and re-ordering of the topic guides in later focus groups ensured we could cover all aspects of the Framework adequately.ConclusionAdapting the Quality Maternal and Newborn Care Framework enabled us to focus on aspects of care which worked well and which didn’t work well for these key stakeholders. Identifying ‘what works for whom and why’ in different models of care is a necessary step in reinforcing and replicating the most effective models of care.

Using a quality care framework to evaluate user and provider experiences of maternity care: A comparative study

“…This study set out to adapt the QMNC Framework for use as a topic guide to evaluate experiences concerning maternity care, this being our first step in developing a maternity care evaluation toolkit. In our initial paper, we reported what we did and how we did this (Symon et al 2018). In this current paper and the accompanying one, we have reported and compared the findings from the focus groups which explored service user and service provider experiences of a range of different models of care.…”

“…We refer the reader to our accompanying paper's Methods section. Briefly, and as reported in Symon et al (2018), two Research Assistant (RA) midwives from two Scottish Health Board areas (HB1, HB2) were seconded firstly to help recruit participants and then to facilitate, document and analyse the focus group discussions. The two health boards were chosen because between them they offered a range of models of care: Modified Universal provision including alongside midwifeled unit; 'High risk' model; Caseload model, including stand-alone units.…”

“…Data were collected via focus groups involving service users and service providers (details provided in Participants section below), the topic guides for which were produced by distilling the characteristics of care described in each of the QMNC Framework's five components. The topic guides are available in our open access paper (Symon et al 2018). In this paper we compare midwives' and obstetricians' perceptions, and then compare the perceptions of service users and service providers.…”

“…In the first of these two linked papers (Symon et al 2019, tbc) we set out the context of recent changes in maternity care arising from midwife-led continuity of care, and the need to identify how such models work in order to be able to extend or replicate them. Following Bharj et al's (2016) proposal that the QMNCF can be used as a structure around which improvements in midwifery can be made globally, in 2018 we reported the adaptation of the QMNC Framework for use as a topic guide in evaluating different models of maternity care (Symon et al 2018). This was done in an area of Scotland which provides three of the four models described in a recent global taxonomy of maternity care (Symon et al 2017).…”

“…We therefore assessed the potential for adapting the QMNC Framework for use as a topic guide in focus groups involving pregnant women, new mothers, midwives and obstetricians in a study in eastern Scotland in 2017. The Symon et al (2018) paper described the process of that study. The current paper is the second of two linked reports of the study's findings.…”