Identifying research priorities for midwifery in Ireland

Strategies to enhance risk communication about medicines in Malaysia: a Delphi study among multinational experts

BACKGROUND

Effective risk communication about medicines is crucial to the success of all pharmacovigilance activities but remains a worldwide challenge. Risk communication has been conducted in Malaysia for decades, yet awareness on the communication methods remains low among healthcare professionals. While international guidelines are available, clear guidance on effectively communicating the risks of medicines in specific countries is scarce. This study aimed to establish a consensus on the priority strategies for enhancing risk communication about medicines by regulators.

METHODS

We conducted a two-round modified Delphi survey among local and international communication experts, and also recipients of medicines risk communication in Malaysia. We developed a list of 37 strategies based on the findings of our previous studies. In Round 1, participants were asked to rate the priority for each strategy using a 5-point Likert scale and suggest additional strategies via free-text comments. Strategies scoring a mean of ≥ 3.75 were included in Round 2. We defined consensus for the final list of strategies a priori as > 75% agreement. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

Our final Delphi panel (n = 39, 93% response rate) comprised medicines communication experts from nine countries and Malaysian healthcare professionals. Following Round 1, we dropped 14 strategies and added 11 strategies proposed by panellists. In the second round, 21 strategies achieved consensus. The priority areas identified were to improve the format and content of risk communication, increase the use of technology, and increase collaboration with various stakeholders. Priority ratings for the strategy "to offer incentives to pharmaceutical companies which maintain effective communication systems" were significantly higher among recipients compared to communicators [χ2(1, N = 39) = 10.1; p = 0.039] and among local versus international panellists [χ2(1, N = 39) = 14.3; p = 0.007].

CONCLUSIONS

Our study identified 21 priority strategies, which were used to develop a strategic plan for enhancing medicines risk communication. This plan is potentially adaptable to all countries with developing pharmacovigilance systems. The difference in views between communicators and recipients, as well as local and international panellists, highlights the importance of involving multiple stakeholders in research.

Working with private hospital midwives in Victoria, Australia to identify practice change priorities: Outcomes of a Delphi study

OBJECTIVE/AIM

In this study, we invited midwives working at one metropolitan private hospital in Victoria, Australia to identify their workplace change needs and priorities for research.

METHODS

In this two-round Delphi study, all midwifery staff within the maternity unit of a private hospital in Melbourne, Australia were invited to participate. In round one, participants joined face-to-face focus groups to put forward their ideas for workplace change and research ideas, and these data were developed into themes. In round two, participants ranked the themes in priority order.

FINDINGS

The top four themes identified by this cohort of midwives were: 'Ways of working - investigating alternate ways of working to enable greater flexibility and opportunities'; 'Understanding midwifery - working with the executive team to highlight the nuances of maternity care'; 'Education - increase in staff in the education team to provide a greater presence and opportunity for education'; and 'Postnatal specific - review ways of working in postnatal areas'.

KEY CONCLUSIONS

A number of priority research and change areas were identified which, if implemented, would strengthen both midwifery practice and midwife retention in this workplace. The findings will be of interest to midwife managers. Further research to evaluate the process and success of implementing the actions identified in this study would be valuable.

Research priorities for maternal and perinatal health clinical trials and methods used to identify them: A systematic review

OBJECTIVE

Research prioritisation helps to target research resources to the most pressing health and healthcare needs of a population. This systematic review aimed to report research priorities in maternal and perinatal health and to assess the methods that were used to identify them.

METHODS

A systematic review was undertaken. Projects that aimed to identify research priorities that were considered to be amenable to clinical trials research were eligible for inclusion. The search, limited to the last decade and publications in English, included MEDLINE, EMBASE, CINHAL, relevant Cochrane priority lists, Cochrane Priority Setting Methods Group homepage, James Lind Alliance homepage, Joanna Brigg's register, PROSPERO register, reference lists of all included articles, grey literature, and the websites of relevant professional bodies, until 13 October 2020. The methods used for prioritisation were appraised using the Reporting Guideline for Priority Setting of Health Research (REPRISE).

FINDINGS

From the 62 included projects, 757 research priorities of relevance to maternal and perinatal health were identified. The most common priorities related to healthcare systems and services, pregnancy care and complications, and newborn care and complications. The least common priorities related to preconception and postpartum health, maternal mental health, contraception and pregnancy termination, and fetal medicine and surveillance. The most commonly used prioritisation methods were Delphi (20, 32%), Child Health Nutrition Research Initiative (17, 27%) and the James Lind Alliance (10, 16%). The fourteen projects (23%) that reported on at least 80% of the items included in the REPRISE guideline all used an established research prioritisation method.

CONCLUSIONS

There are a large number of diverse research priorities in maternal and perinatal health that are amenable to future clinical trials research. These have been identified by a variety of research prioritisation methods.

Midwives' empathy and shared decision making from women's perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care

Background

For quality-oriented evaluation of prenatal and obstetric care, it is important to systematically consider the perspective of the women receiving care in order to comprehensively assess and optimize quality in a woman-centered manner. Empathy and Shared Decision Making (SDM) are essential components of woman-centered midwifery care. The aim of the study was to analyze measurement invariance of the items of the Consultation and Relational Empathy (CARE) and Shared Decision Making-Questionnaire (SDM-Q-9) scales depending on the prenatal versus obstetric care setting.

Methods

One hundred fifty women retrospectively assessed aspects of woman-centered midwifery care in both prenatal and obstetric care setting. The birth of the child was a maximum of 12 months ago. A structural equation modelling approach was adopted to separate true effects from response shift (RS) effects depending on care setting. The latter were analyzed in terms of recalibration (changing women’s internal measurement standards), Reprioritization (changing associations of items and construct) as well as Reconceptualization (redefining the target construct).

Results

A response shift model was identified for both assessments (pregnancy/birth: CFI = .96/.96; SRMR = .046/.051). At birth, both scales indicated lower quality of care compared with prenatal care (SDM-Q-9-M/CARE-8-M:|d| = 0.190/0.392). Although no reconceptualization is required for the items of both scales, RS effects are evident for individual items. Due to recalibration and reprioritization effects, the true differences in the items are partly underestimated (SDM-Q-9-M/CARE-8-M: 3/2 items) or overestimated (4/2 items).

Conclusion

The structure of the constructs SDM and Empathy, indicating woman-centered midwifery care, are moderated by the care settings. To validly assess midwives’ empathy and shared decision making from women’s perspective, setting-dependent response shift effects have to be considered. The proven item-specific response effects contribute to a better understanding of construct characteristics in woman-centered care by midwives during pregnancy and childbirth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05041-y.

Identifying the priorities for midwifery education across Australia and New Zealand: A Delphi study

PROBLEM

In countries where education programmes are assessed as meeting international standards there is limited knowledge about the challenges facing midwifery education.

BACKGROUND/AIM

The positive impact of quality midwifery education on maternal and newborn health is acknowledged by the World Health Organisation. However, there is limited research identifying the issues faced in providing quality midwifery education. The aim of this study was to identify the challenges and determine priority projects to strengthen midwifery education across Australia and New Zealand.

METHODS

A two-round Delphi study with experts in midwifery education was undertaken.

FINDINGS

In round one, 85 participants identified an initial 366 issues for midwifery education. Through thematic content analysis these were categorised into 89 statements reflecting five major themes: In round two, 105 midwifery experts from Australia n=86 (79%) and New Zealand n=23 (21%) rated the 89 statements in order of priority. Across the combined data (Australia and New Zealand) a total of 19 statements gained consensus of ≥80%.

DISCUSSION

Five priority themes were identified including; (1) enabling success of First Peoples/Māori midwifery students; (2) increasing the visibility and influence of midwifery within regulation, accreditation and university governance; (3) determining how best to deliver the clinical practicum component of programmes; (4) reviewing midwifery programmes to enhance design, content and delivery; and (5) ongoing education and support for the midwifery workforce.

CONCLUSION

In Australia and New Zealand, it is imperative that collaborative work is undertaken to design and action identified projects addressing these priorities.

Nurse-identified patient care and health services research priorities in the United Arab Emirates: a Delphi study

BACKGROUND

The need for improved research on ill health has been recognized internationally and locally in the United Arab Emirates (UAE). The UAE Nursing and Midwifery Council recently committed to enhancing the status and contributions of nursing in healthcare research across the UAE by establishing a National Committee for Research Development. This study using a Delphi method to identify research priorities from the perspective of nurses delivering frontline healthcare.

METHODS

A two-phase Delphi design was implemented with 1032 nurses participating in phase one of the study and 1339 in phase two.

RESULTS

The most important priority was patient safety and healthcare professionals' awareness of international patient safety goals (including staffing levels and shift length) and potential effects on patient safety. Other important priorities were infection control practices and management of communicable diseases.

CONCLUSIONS

These priorities may inform nursing research programs to improve patient care and health outcomes in the UAE and similar contexts worldwide.

Global Midwifery Research Priorities: An International Survey

PURPOSE: This exploratory project aimed to provide an up-to-date list of global midwifery research priorities to inform the International Confederation of Midwives’ (ICM) research strategy for development of its research agenda.

DESIGN: An online survey conducted in 2014 asked ICM Research Advisory Networking members (who then disseminated it to a wider midwifery research interest group) to grade the importance of research priorities and provide further suggestions. Research priorities listed were based on those identified in previous scoping exercises and a recent literature review.

FINDINGS: Two hundred seventy-one respondents from 37 countries completed the questionnaire including midwifery practitioners, researchers, lecturers, and service providers. Promotion of normal birth, prevention of maternal and fetal/neonatal morbidity and mortality, and psychosocial aspects of maternity care were identified by the respondents as the top three important themes. Subanalysis by country, region, and continent found promotion of normal birth the greatest priority in more resourced regions, whereas prevention of maternal and fetal/neonatal morbidity and mortality was the most important research priority in less resourced locations.

CONCLUSION: This study provides a systematic global mapping of research priorities from midwives’ perspectives which will inform the ICM research agenda. Geographical variation in key research priorities reflect midwives working in very different settings with specific local health and resource related challenges such as staff shortages, human immunodeficiency virus, or obesity. Future research should aim to address these priorities to improve maternal and infant health. Limited number of respondents from some geographical areas should be borne in mind when interpreting the global implications and further research with an optimized scoping for inclusion is required to ensure adequate representativeness from all countries.

Leading Change and Advancing Health by Enhancing Nurses' and Midwives' Knowledge, Ability and Confidence to Conduct Research through a Clinical Scholar Program in Western Australia

This paper reports on an evaluation of a Clinical Scholar Program initiated at a hospital in Western Australia. The aim of the program was to build the capacity of nurses and midwives to conduct research and evidence-based practice within the hospital. The program was based on a previous program and consisted of six teaching days and four hours per month release for proposal preparation. At the end of the program participants were asked to complete a short anonymous questionnaire. The answers were analysed using standard processes of qualitative analysis. Themes emerging from the data included program strengths, individual gains, ability to conduct research, and areas for improvement. The findings highlighted that, while the participants considered that they were more knowledgeable and confident to conduct research, they still required support. The Clinical Scholar Program has provided a way to increase the capacity of clinicians to participate in research activities.

'Not enough people to look after you': an exploration of women's experiences of childbirth in the Republic of Ireland

OBJECTIVE

Women's experiences of childbirth have far reaching implications for their health and that of their babies. This paper describes an exploration of women's experiences of childbirth in the Republic of Ireland.

DESIGN

A qualitative descriptive study consisting of focus group interviews (FGIs) identified important aspects of women's childbirth experiences.

SETTING

Four randomly selected maternity units in the Republic of Ireland. The pilot study unit was also included in the data collection.

PARTICIPANTS

A convenience sample of 25 women who volunteered to participate in five focus group interviews. Eligible participants were >18 years, able to discuss their birth experiences in English, had experienced labour, and had a live healthy baby.

DATA COLLECTION

Approximately three months following the birth, data were collected using a conversational low moderator style focus group interviews.

FINDINGS

Three main themes were identified, 'getting started', 'getting there' and 'consequences'. Women experienced labour in a variety of contexts and with differing aspirations. Midwives played a pivotal role in enabling or disempowering positive experiences. Control was an important element of childbirth experiences. Women often felt alone and unsupported. The busyness of the hospital units precluded women centred care both in early labour and in the period following the birth. Some women would not have another baby due to their childbirth experiences.

KEY CONCLUSIONS

The context within which women give birth in the Republic of Ireland is important to their birth experiences. Although positive experiences were reported many women felt anxious and isolated. Busy environments added to women's fears and participants appeared to accept the lack of support as inevitable. Midwives play a pivotal role in helping women achieve a positive birth experience.

IMPLICATIONS FOR PRACTICE

Excluding women's views from service evaluation renders an incomplete and somewhat distorted depiction of childbirth in Ireland. Although women appear to be satisfied with a live healthy baby, the process of 'getting there' has an emotional and psychological dimension that is important to the experience. Measuring the quality of maternity services must encompass recognition of psychological and emotional well-being alongside physical safety.