Table 3

Thematic framework derived from nominal group ideas

Theme	Description	Subthemes
Respect for person-centred care	Treating service users with dignity and considering their unique needs, preferences and values, for example, shared decision-making during appointments, listening to mother’s needs and respecting birth plans, respecting body autonomy.	Listening to service user needs Respecting patient choice Informed consent
Information and education	Providing service users with better quality and tailored information and education, for example, face-to-face health education appointment for all mothers that is separate to ANC visits, improving quality of patient information on websites, leaflets, social media.	Quality of information provided Availability and quality of translation and interpretation services
Advocacy mechanisms	Strategies to support service users to assert their rights and voice their concerns, for example, community advocates working within hospital settings, raising awareness of birthrights resources, improving feedback loop within complaints process.	Use of community advocates Supporting service users to advocate for themselves Improving transparency and use of complaints process
Mental health	Mental health support during antenatal, labour/childbirth and postnatal period, for example, counselling and emotional support during pregnancy, personalised and culturally appropriate mental health support, mental health teams supporting both parents.	Mental health support for mothers Mental health support for husbands and partners
Involvement of friends and family	Involving immediate support network of service users in all stages of care and when improving services, for example, tailored antenatal classes for Black fathers, using Black male NHS health professionals as role models to support Black fathers.	Involving men and partners at all stages of care Support for birth partner selection
Access	Accessing of care, for example, out-of-hours support, earlier uptake of first ANC appointment.	Limited access Sustaining continued patient engagement with services
Staff knowledge and capabilities	Training and support for staff to deliver quality care for Black families, for example, increasing cultural competency of workforce through mythbusting and cultural safety training and diverse recruitment, improving staff to patient ratios.	Culturally competent care training Communication training Staff health and well-being
Ethnicity-based safety risks	Increased education and awareness of ethnicity-based patient safety risks, for example, staff awareness of safety risks specific to service users from Black heritage groups.	Identifying patient safety warning signs (eg, vital signs) Reducing ethnic biases in medical devices
Organisational policies	Initiatives and policies that are governed by organisational structures, processes and culture, for example, prioritisation of EDI values, shared learning system for safety incidents related to Black mothers, zero tolerance policy for discrimination towards patients.	Learning safety culture Staff disciplinary measures Improve data collection and monitoring Culturally appropriate catering
Community partnerships	Building trusted relationships with communities to improve services, for example, sustained engagement with communities by maternity hospital staff, professional-community networking events to understand needs.	Community engagement Community co-production of services
Coordination and integration of care	Communication and collaboration between organisations within an integrated care system, for example, continuity of midwifery care, clearer signposting to non-health-related resources (housing, economic support), partnerships with community and schools to increase maternal health knowledge and engagement at early age.	Continuity of care and carer Integrated system working (health, local authority, voluntary sector, community) Intersectional and holistic support for families Neonatal intensive care experience for parents

ANC, antenatal care; EDI, equality, diversity and inclusion; NHS, National Health Service.