Using a quality care framework to evaluate user and provider experiences of maternity care: A comparative study

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

Five hundred and forty mothers completed the survey (Australia 136; Ghana 131; India 153; UK 120). Construct validity: Cronbach's α 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 to 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.

Investigation of negative emotions and sleep quality in gastric cancer patients and intervention strategies

Objective

This study investigates the prevalence of negative emotions and sleep disturbances in gastric cancer patients, explores their relationship, and suggests targeted interventions to enhance their physical and mental well-being.

Methods

A total of 650 gastric cancer patients from the First Affiliated Hospital of Soochow University (March 2020 to March 2023) were included. Negative emotions, including anxiety and depression, were assessed using the Positive and Negative Affect Schedule (PANAS), while sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics and Pearson correlation analysis were employed to analyze the data and explore the relationship between negative emotions and sleep quality.

Results

Of the 650 patients, 533 (82%) exhibited negative emotions, and 560 (86.15%) experienced sleep disturbances. A significant positive correlation was found between negative emotion scores and sleep quality (r = 0.682, p < 0.05). Patients with poor sleep quality had significantly higher negative emotion scores (p < 0.05). Factors such as gender, age, tumor stage, and education level influenced negative emotion scores, while room type significantly impacted sleep quality (p < 0.05).

Conclusion

Negative emotions and sleep disturbances are common and interrelated in gastric cancer patients. Addressing psychological factors, particularly anxiety and depression, is crucial for improving sleep quality and overall recovery. Integrated psychological and sleep management interventions should be incorporated into routine care to improve patients' quality of life and treatment outcomes.

"A safe space"; A statewide evaluation of Midwifery Antenatal and Postnatal Service (MAPS) using the quality maternal newborn care, evidence informed framework

BACKGROUND

The World Health Organization recommends Midwifery Continuity of Care (MCoC) due to the consistent improvements in outcomes for mothers and babies. Surveys from the United Kingdom and Australia reported large numbers of midwives are unable to commit to the on call component required to provide MCoC across the continuum. To address this challenge a modified MCoC model called Midwifery Antenatal and Postnatal Services (MAPS) has been introduced. The aim of this study was to evaluate MAPS services in six sites across one State in Australia.

METHODS

A multi-site qualitative descriptive study was undertaken framed by the Quality Maternal Newborn Care (QMNC) Framework. The QMNC framework was used to develop focus group questions for data collection, and as a lens for analysing data. Data were collected via focus groups from midwives and women at six sites ranging from metropolitan to regional and rural settings and thematically analysed.

FINDINGS

Participants (n=80) included women (n=28), midwives (n=44) and MAPS managers (n=8). This paper reports the findings from the women and midwives, presented under three themes: Getting onto the program, Knowing the story and Building confidence by sharing information. Each theme had subthemes and the findings were aligned either positively or negatively with the QMNC framework.

CONCLUSION

This study found the MAPS model aligns in positive ways with the QMNC quality care framework with some recommendations to improve quality care. Midwives want to provide continuity of care and MAPS is a useful model for providing continuity through the antenatal and postnatal periods.