Abstract
Background: Continuity of midwifery care is considered the gold standard for maternity care, with strong evidence supporting its effectiveness and resulting higher levels of satisfaction among women compared to standard care. This model involves a woman building a relationship with a known midwife throughout pregnancy, labour, birth, and the postnatal time. Patient satisfaction, considered as important as clinical outcomes, plays a key role in shaping healthcare services. Most instruments developed to measure satisfaction are based on the fragmented model of maternity care. To date there has been no robust, validated instrument available to measure maternal satisfaction with continuity of midwifery care. The research project aims to develop a reliable tool to measure satisfaction in continuity of midwifery care, addressing gaps in existing surveys that focus on fragmented models of care.Methods: A pragmatic approach was taken with four projects contributing to the aim of this thesis. These developed in a progressive manner with each project subsequently informing the next. Each project used methods that were appropriate to their aim.
Results: The first project was an integrative, systematic review of the literature with a focus on identifying existing instruments used to measure maternal satisfaction within continuity, midwifery models of care. The findings confirmed that there are no existing suitable instruments for measuring maternal satisfaction with continuity of midwifery care. The second project was a systematic review of qualitive works with meta-synthesis identifying the factors that women value in the continuity of midwifery model of care. The meta-synthesis highlighted the importance of the relationship between the woman and midwife. It was through this relationship that trust, personalised care and empowerment were facilitated. The third project used a modified Delphi Method to develop items for a new instrument to measure maternal satisfaction with continuity of midwifery care. Panel members included maternity care researchers, obstetrician, midwifery managers (in rural and regional settings) and women. The instrument was named COMcareSS (Continuity of Midwifery Care Satisfaction Survey) following consensus by panel members. The full questionnaire included 59 questions (56 requiring Likert scale responses and 3 open ended) with the scale comprising 35 items that focuses on midwifery care within the context of a continuity model. The fourth and final project allowed for the evaluation of the COMcareSS with a sample of 272 women. Validity and reliability were demonstrated with factor analysis identifying one factor with good reliability.
Conclusion: The Continuity of Midwifery Care Satisfaction Survey (COMcareSS) is a reliable tool that will contribute to the provision of useful feedback in continuity of midwifery care services, in research and in benchmarking between services.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Deborah DAVIS (Supervisor), Jan TAYLOR (Supervisor) & Marjorie BARNWELL (Supervisor) |