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. 2024 Apr 24;33(5):301-313.
doi: 10.1136/bmjqs-2021-014329.

Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders

Lisa Hinton  1 , Francesca H Dakin  2 , Karolina Kuberska  3 , Nicola Boydell  4 , Janet Willars  5 , Tim Draycott  6 , Cathy Winter  7 , Richard J McManus  2 , Lucy C Chappell  8 , Sanhita Chakrabarti  9 , Elizabeth Howland  10 , Jenny George  11 , Brandi Leach  11 , Mary Dixon-Woods  3
Affiliations

Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders

Lisa Hinton et al. BMJ Qual Saf. .

Abstract

Background: High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it.

Methods: This UK-wide study involved interviews and an online survey inviting free-text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system-level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers.

Findings: Participants included 106 pregnant women and 105 healthcare professionals and managers/stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person-centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety.

Conclusions: This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research.

Keywords: health services research; healthcare quality improvement; obstetrics and gynecology; qualitative research; womens health.

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Conflict of interest statement

Competing interests: TD is Vice President of the Royal College of Obstetricians and Gynaecologists. RJM has previously received BP monitors from Omron Healthcare for research purposes and is working with them on a telemonitoring system.

References

    1. Office for National Statistics . Births in England and Wales: 2019. ons.gov.uk, 2020.
    1. Northern Ireland Statistics and Research Agency . Registrar General annual report 2019. nisra.gov.uk, 2020.
    1. National Records of Scotland . Vital events reference tables 2019. nrscotland.gov.uk, 2020.
    1. Widdows K, Roberts SA, Camacho EM, et al. Stillbirth rates, service outcomes and costs of implementing NHS England's saving babies' lives care bundle in maternity units in England: a cohort study. PLoS One 2021;16:e0250150. 10.1371/journal.pone.0250150 - DOI - PMC - PubMed
    1. Knight MBK, Tuffnell D, Shakespeare J, et al., eds. on behalf of MBRRACE-UK,. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from theUK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18. Oxford: d: National Perinatal Epidemiology Unit, University of Oxford, 2020.

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