Table 2

Framework for quality in remote antenatal care (created by the authors)

Quality domainKey features of domain for remote antenatal care
Efficiency and timeliness
Avoiding waste of time, effort, supplies, ideas and energy
Remote antenatal care should be convenient for both women and professionals. It should avoid wasting people’s time, but women should not feel rushed. Safeguards should be in place to ensure that shared understanding between teams is not lost.
Services are based on high quality evidence
Care should be based on the best currently available evidence appropriate to women’s clinical circumstances. There should be a commitment to building an evidence-base to compare outcomes of remote care with in-person care.
Care that minimises or eliminates risks of avoidable harm to mother and/or baby
Safety should be broadly conceived to include both clinical outcomes (including mental health) and protection of vulnerable groups including those at risk of exposure to domestic violence and social isolation. There should be an emphasis on building evidence about the safety of remote care.
Care can be accessed easily by all without barriers to use
Considerations of accessibility should focus on what forms of care are suitable for remote provision and for whom, and which forms of care are less suitable and for whom. The resource requirements for remote care should not pose barriers to accessing antenatal care.
Equity and inclusion
Care that does not vary in quality or accessibility according to characteristics such as location, ethnicity, socioeconomic status or sex-gender
Remote antenatal care should be available and accessible to all, not just the digitally-enabled and health literate. The design of remote care pathways should be highly attentive to issues of equity, diversity and inclusion, including the disadvantages in relation to digital poverty, literacy and other forms of capital that may be experienced by groups at risk of marginalisation.
Care that is respectful of and responsive to individual patient needs, preferences, needs and values
Care should be delivered in a way that addresses individual circumstances and preferences, and supports relationships. People should feel able to raise concerns.
Choice and continuity
Care should be designed to respond to individual choices and preferences, with continuity of care where possible
Continuity of care—particularly relational continuity—should be identified as an important consideration in antenatal pathways, including where they include remote components. Choices about modes of care should be offered where possible, with shared decisions made and reassessed in light of changing risk and preference.