Selecting contextually appropriate performance indicators for Northern maternity care systems: A modified Delphi approach

Abstract

Background Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in Northern regions. Methods A scoping review generated a working list of indicators. Fourteen maternity care and health systems experts then participated in a modified Delphi consensus process. Participants rated proposed indicators according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration. Results Consensus was achieved after two rounds. Eleven indicators were rated highly on all four criteria. Twenty-nine indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Conclusions The Delphi approach was effective in identifying indicators for maternity care in Northern regions. Further research and collaboration with key stakeholders is necessary to further develop indicators of health system responsiveness and accessibility.