Validating the Quality Maternal and Newborn Care Framework index: a global tool for quality-of-care evaluations

Background: Quality maternity care is known to improve a range of maternal and neonatal outcomes. The Lancet Series on Midwifery’s Quality Maternal and Newborn Care (QMNC) Framework is a high-level synthesis of the global evidence on quality maternity care. Initial qualitative work demonstrated the Framework’s adaptability in evaluating service user and provider perceptions of the quality of maternity care. However, evaluating services at scale requires a survey instrument. This paper reports the validation of the QMNC Framework index (QMNCFi), a five-part survey for the evaluation of maternity care across diverse settings.

Methods: International online English language survey of women who had given birth in the previous year in Australia, Ghana, India and the United Kingdom (UK). It was distributed through service user networks (UK and Australia) and at postnatal clinics (Ghana and India). All forms were completed online. Test-retest was conducted to assess reliability.

Results: 540 mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach’s Alpha in 12 of the survey’s 13 sections ranged from 0.795 to 0.986; for the remaining section the alpha was 0.594. Reliability: 55 participants completed the QMNCFi a second time. Intraclass correlation coefficient results ranged from 0.657-0.939 across the 13 sections. Field researchers in Ghana and India reported that the survey was easily understood and completed.

Conclusion: This survey has shown that, across diverse contexts, the QMNCFi is a valid, reliable and comprehensive tool for measuring service user perceptions of the quality of care over time.