https://orcid.org/0000-0002-7415-2571
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ABSTRACT
Background
Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored.
Objective
The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices.
Methods
A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled.
Results
The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships.
Conclusions
This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings.
Responsible Editor Maria Emmelin
Responsible Editor Maria Emmelin
Acknowledgments
We thank the seven Midwize Ambassadours and all the informants for their valuable contribution to this study.
Author contribution
JB: Conceptualisation, Methodology, Investigation, Formal Analysis, Writing – original draft. MW: Conceptualisation, Formal analysis. Writing – review and editing. KE: Investigation. Writing – review and editing. DA: Writing – review and editing. LK: Investigation, Writing – review and editing. HL: Conceptualisation. Formal analysis, Supervision, Writing – review and editing. All authors read and approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
Ethics permission was granted through Makerere SPH Research and Ethics Committee (Ref.nr: SPH-2021-174), the Uganda National Council for Science and Technology (Ref.nr: HS1885ES), and the Swedish Ethical Review Authority (Ref.nr: 2021–05539–01)
All individuals who agreed to participate signed an informed consent form before data collection. Participants were assured of confidentiality regarding their information and were informed that opting out of participation would not affect their care or work environment.
Paper context
This study provides a practical example of a co-creation process for developing a quality improvement intervention on evidence-based midwifery practises. The intervention becomes relevant and compatible with guidelines and needs through the co-creation approach used in this study, bridging the evidence-to-action gap in maternal healthcare. It is recommended that more maternal healthcare interventions be co-created and that the finding in this study is used as an inspiration in future midwife-led quality improvement efforts.