Measuring Client Experiences in Maternity Care under Change: Development of a Questionnaire Based on the WHO Responsiveness Model

Abstract

BackgroundMaternity care is an integrated care process, which consists of different services, involves different professionals and covers different time windows. To measure performance of maternity care based on clients' experiences, we developed and validated a questionnaire.Methods and FindingsWe used the 8-domain WHO Responsiveness model, and previous materials to develop a self-report questionnaire. A dual study design was used for development and validation. Content validity of the ReproQ-version-0 was determined through structured interviews with 11 pregnant women (≥28 weeks), 10 women who recently had given birth (≤12 weeks), and 19 maternity care professionals. Structured interviews established the domain relevance to the women; all items were separately commented on. All Responsiveness domains were judged relevant, with Dignity and Communication ranking highest. Main missing topic was the assigned expertise of the health professional. After first adaptation, construct validity of the ReproQ-version-1 was determined through a web-based survey. Respondents were approached by maternity care organizations with different levels of integration of services of midwives and obstetricians. We sent questionnaires to 605 third trimester pregnant women (response 65%), and 810 women 6 weeks after delivery (response 55%). Construct validity was based on: response patterns; exploratory factor analysis; association of the overall score with a Visual Analogue Scale (VAS), known group comparisons. Median overall ReproQ score was 3.70 (range 1–4) showing good responsiveness. The exploratory factor analysis supported the assumed domain structure and suggested several adaptations. Correlation of the VAS rating and overall ReproQ score (antepartum, postpartum) supported validity (r = 0.56; 0.59, p<0.001 Spearman's correlation coefficient). Pre-stated group comparisons confirmed the expected difference following a good vs. adverse birth outcome. Fully integrated organizations performed slightly better (median = 3.78) than less integrated organizations (median = 3.63; p<0.001). Participation rate of women with a low educational level and/or a non-western origin was low.ConclusionsThe ReproQ appears suitable for assessing quality of maternity care from the clients' perspective. Recruitment of disadvantaged groups requires additional non-digital approaches.

Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study

“…This is not surprising, since it is known that women who perceive no health problems for themselves or their infant have better experiences. The women giving birth in a hospital under supervision of an obstetrician are high-risk women and, therefore, probably more anxious or worried about their own or their infant's health (Scheerhagen et al, 2015).…”

“…Responsiveness is defined as 'aspects of the way individuals are treated and the environment in which they are treated during health system interactions' (Scheerhagen et al, 2015). The postnatal part of the ReproQ was used in this study and includes two reference periods: the event of labour and birth and the subsequent postpartum week.…”

“…An average score per domain was computed this way. The questionnaire avoids any implicit or explicit preference towards the providers or the organizational structures, leaving room to compare different organizational structures and different levels of care (Scheerhagen et al, 2015).…”

“…Responsiveness is defined as aspects of the way individuals are treated and the environment in which they are treated during health system interactions (Murray and Frenk, 2000;Valentine et al, 2003). The concept has been applied in the Dutch maternity care a few times before (van der Kooy et al, 2014;Scheerhagen et al, 2015).…”

Quality improvement opportunities for handover practices in birth centres: A case study from a process perspective

“…Continuity of caregiver was present in 4 birth centres with postpartum care available in 3 centres. (Un)Familiarity of the woman with the caregiver is an aspect that can largely explain the differences in client experiences between transferred and non‐transferred women . These experiences are an important indicator of the quality of health care.…”