Measuring clients' experiences with antenatal care before or after childbirth: it matters

Effects of a Personal Health Record in Maternity Care: A Stepped-Wedge Trial

To improve both the active involvement of pregnant women in their maternal health and multidisciplinary collaboration between maternal care professionals, we introduced a personal health record (PHR) in routine maternity care. We studied the effects of this intervention on the percentage of uncomplicated births, women’s perspectives on quality of care, and the collaboration between health care professionals. We performed a stepped-wedge cluster randomized controlled trial with four clusters and 13 maternity health centers (community-based midwife practices and hospitals) in one collaborative area. In total, 7350 pregnant women and 220 health care professionals participated. Uncomplicated births accounted for 51.8% (95% CI 50.1–53.9%) of total births in the control group and 55.0% (CI 53.5–56.5%) of total births in the intervention group (p = 0.289). Estimated means revealed that the differences detected in the stepped-wedge study were due to time and not the intervention. Women’s perspectives on quality of care and collaboration between health care professionals revealed no relevant differences between the control and intervention groups. The introduction of the PHR resulted in no significant effect on the chosen measures of quality of maternal care. The suggested positive effect in the raw data was a local trend which was less visible in the national database, and thus might be related to subtle changes toward an improved collaborative culture in the study region.

The discriminative power of the ReproQ: a client experience questionnaire in maternity care

Background

The aim of the ReproQuestionnaire (ReproQ) is to measure the client’s experience with maternity care, following WHO’s responsiveness model. To support quality improvement, ReproQ should be able to discriminate best from worst organisational units.

Methods

We sent questionnaires to 27,487 third-trimester pregnant women (response 31%) and to 37,230 women 6 weeks after childbirth (response 39%). For analysis we first summarized the ReproQ domain scores into three summary scores: total score (all eight domains), personal score (four personal domains), and setting score (four setting domains). Second, we estimated the proportion of variance across perinatal units attributable to the ‘actual’ difference across perinatal units using intraclass correlation coefficients (ICCs). Third, we assessed the ability of ReproQ to discriminate between perinatal units based on both a statistical approach using multilevel regression analyses, and a relevance approach based on the minimally important difference (MID). Finally, we compared the domain scores of the best and underperforming units.

Results

ICCs ranged between 0.004 and 0.025 for the summary scores, and between 0.002 and 0.125 for the individual domains. ReproQ was able to identify the best and worst performing units with both the statistical and relevance approach. The statistical approach was able to identify four underperforming units during childbirth (total score), while the relevance approach identified 10 underperforming units.

Conclusions

ReproQ, a valid and efficient measure of client experiences in maternity care, has the ability to discriminate well across perinatal units, and is suitable for benchmarking under routine conditions.