A comparison of data obtained from service providers and service users to assess the quality of maternity care

Abstract

Objective: to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland.

Design: an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users.

Participants: lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period.

Data collection: structured group interviews with service providers and a questionnaire survey of recently delivered women.

Data analysis: professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test.

Findings: a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses.

Conclusions and implications for practice: this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration.