Midwifery-led antenatal care models

mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care

Andrew Symon (Lead / Corresponding author), Jan Pringle, Helen Cheyne, Soo Downe, Vanora Hundley, Elaine Lee, Fiona Lynn, Alison McFadden, Jenny McNeill, Mary J. Renfrew, Mary Ross-Davie, Edwin van Teijlingen, Heather M. Whitford, Fiona Alderdice

Research output: Contribution to journalArticle

10 Citations (Scopus)
116 Downloads (Pure)

Abstract

Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.

Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.

Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.

Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

Original languageEnglish
Article number168
Pages (from-to)1-15
Number of pages15
JournalBMC Pregnancy and Childbirth
Volume16
Issue number1
DOIs
Publication statusPublished - 19 Jul 2016

Fingerprint

Prenatal Care
Midwifery
Mothers
Randomized Controlled Trials
Quality of Health Care
Standard of Care
Mexico
Ireland
Sweden
Canada
China

Keywords

  • Care model
  • Characteristics of care
  • Maternity care
  • Midwifery-led
  • Outcomes
  • Pregnancy
  • Quality
  • Randomised controlled trial

Cite this

Symon, Andrew ; Pringle, Jan ; Cheyne, Helen ; Downe, Soo ; Hundley, Vanora ; Lee, Elaine ; Lynn, Fiona ; McFadden, Alison ; McNeill, Jenny ; Renfrew, Mary J. ; Ross-Davie, Mary ; van Teijlingen, Edwin ; Whitford, Heather M. ; Alderdice, Fiona. / Midwifery-led antenatal care models : mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care. In: BMC Pregnancy and Childbirth. 2016 ; Vol. 16, No. 1. pp. 1-15.
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abstract = "Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.",
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Midwifery-led antenatal care models : mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care. / Symon, Andrew (Lead / Corresponding author); Pringle, Jan; Cheyne, Helen; Downe, Soo; Hundley, Vanora; Lee, Elaine; Lynn, Fiona; McFadden, Alison; McNeill, Jenny; Renfrew, Mary J.; Ross-Davie, Mary; van Teijlingen, Edwin; Whitford, Heather M.; Alderdice, Fiona.

In: BMC Pregnancy and Childbirth, Vol. 16, No. 1, 168, 19.07.2016, p. 1-15.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Midwifery-led antenatal care models

T2 - mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care

AU - Symon, Andrew

AU - Pringle, Jan

AU - Cheyne, Helen

AU - Downe, Soo

AU - Hundley, Vanora

AU - Lee, Elaine

AU - Lynn, Fiona

AU - McFadden, Alison

AU - McNeill, Jenny

AU - Renfrew, Mary J.

AU - Ross-Davie, Mary

AU - van Teijlingen, Edwin

AU - Whitford, Heather M.

AU - Alderdice, Fiona

N1 - This project was undertaken as part of a programme grant from the Scottish Government Chief Nurse’s Office to the SMART (Scottish Midwives Advancing Research Together) collaboration. The views expressed are those of the authors and not of the Scottish Government Chief Nurse’s Office.

PY - 2016/7/19

Y1 - 2016/7/19

N2 - Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

AB - Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

KW - Care model

KW - Characteristics of care

KW - Maternity care

KW - Midwifery-led

KW - Outcomes

KW - Pregnancy

KW - Quality

KW - Randomised controlled trial

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VL - 16

SP - 1

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JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

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