Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol

Abstract

IntroductionOne of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts?Methods and analysisThe review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20–35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance.Ethics and disseminationEthical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426–1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences.PROSPERO registration numberCRD42021288702.

Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement

“…The project originated from a midwifery-led research priority setting exercise undertaken in Nottingham/Nottinghamshire in 2020 involving several organisations, including a maternity research public involvement group – the ‘Nottingham Maternity Research Network’ (NMRN; Evans et al, 2021 ). A service user representative from the NMRN subsequently became a co-applicant on the funding bid, thus embedding service user engagement into the project from the outset.…”

“…One component of digital transformation relates to changes in consultation modality – in which face-to-face healthcare interactions are replaced or supplemented with digital, remote or virtual means (telephone or video calls). This paper reports on an ongoing evidence synthesis project – focused on the maternity setting – that uses a realist methodology to explore how digital clinical consultations can be implemented in a clinically safe, appropriate and acceptable way ( Evans et al, 2022 ). Within the project, the term ‘digital clinical consultation’ (hereafter referred to as DC-CON) is defined as follows: Synchronous telephone or video consultations involving direct interaction between a service user and a maternity healthcare professional.…”