WHO standards-based tool to measure women’s views on the quality of care around the time of childbirth at facility level in the WHO European region: development and validation in Italy

Abstract

ObjectivesA comprehensive WHO standards-based tool to measure women’s perceived quality of maternal and newborn care (QMNC) in health facilities is needed to allow for comparisons of data across settings and over time. This paper describes the development of such a tool, and its validation in Italy.DesignA multiphase, mixed-methods study involving qualitative and quantitative research methods.SettingNine health facilities in Italy.MethodsThe questionnaire was developed in six phases: (1) Defining the scope, characteristics and a potential list of measures for the tool; (2) initial content and construct validation; (3) first field testing to assess acceptability and perceived utility for end-users (1244 women, 35 decision makers) and further explore construct validity; (4) content optimisation and score development; (5) assessment of face validity, intrarater reliability and internal consistency and (6) second field testing in nine maternity hospitals (4295 women, 78 decision-makers).ResultsThe final version of the tool included 116 questions accounting for 99 out of the 350 of the extended lists of WHO Quality Measures. Observed face validity was very good, with 100% agreement for 101 (87%) questions and Kappa exceeding 0.60 for remaining ones. Reliability was good, with either high agreement or Kappa exceeding 0.60 for all items. Cronbach alpha values ranged from 0.84 to 0.88, indicating very good internal consistency. Acceptability across seven hospitals was good (mean response rate: 57.4%, 95% CI 44.4% to 70.5%). The questionnaire proved to be useful, driving the development of actions plan to improve the QMNC in each facility.ConclusionsStudy findings suggest that the tool has good content, construct, face validity, intrarater reliability and internal consistency, while being acceptable and useful. Therefore, it could be used in health facilities in Italy and similar context. More research should investigate how effectively use the tool in different countries for improving the QMNC.

WHO standards-based tools to measure service providers’ and service users’ views on the quality of hospital child care: development and validation in Italy

“…We believe that no single tool can fit all purposes while retaining acceptability. Most tools to measure QOC actually use surveys in service users, since this is an important perspective 14 15 18 28 42 43. Further research is needed to develop tools that cover the population and settings excluded by the two-questionnaire described in this study.…”

“…All Quality Measures with a total score of at least 10 points were selected for the first draft of the questionnaire. Sociodemographic items (age, sex, type of diseases for children, type of health professionals, etc) were chosen and designed according to literature and previous experience 15 23. Indicators relevant to COVID-19 were extracted from existing WHO guidance and relevant literature available 29 30…”

“…The team of experts who reviewed both questionnaires included 49 paediatricians involved in the CHOICE project, with experience both at tertiary and secondary care and senior experts from different settings (Italy and Brazil) with long-term experience in developing and/or using WHO indicators and standards 13 15 17–21 31 32. The WHO Standards13 were made available to experts.…”

“…A simple scoring system (online supplemental table 4) was developed based on examples in literature and previous authors’ experience 15 28. In developing the scoring system, the following key considerations were made.…”

“…Nevertheless, there is a lack of documented experience on how best to collect data on the Quality Measures defined by WHO,13 especially in high-income countries. While tools have been developed to collect data on WHO Quality Measures related to maternal and newborn QOC,14 15 and outpatient and primary care for adolescents,16 no tool yet exists related to the WHO inpatient paediatric standards. In 2019, drawing on previous research conducted on the WHO Standards,17–21 we started a multicentre project called CHOICE (Child HOspItal CarE) aiming at implementing the WHO Standards13 to improve QOC for children and young adolescents in health facilities in Italy and Brazil.…”