RT Journal Article
SR Electronic
T1 Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP bmjqs-2021-014329
DO 10.1136/bmjqs-2021-014329
A1 Lisa Hinton
A1 Francesca H Dakin
A1 Karolina Kuberska
A1 Nicola Boydell
A1 Janet Willars
A1 Tim Draycott
A1 Cathy Winter
A1 Richard J McManus
A1 Lucy C Chappell
A1 Sanhita Chakrabarti
A1 Elizabeth Howland
A1 Jenny George
A1 Brandi Leach
A1 Mary Dixon-Woods
YR 2022
UL http://qualitysafety.bmj.com/content/early/2022/05/12/bmjqs-2021-014329.abstract
AB 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.Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.