Role of Midwifery Continuity of Care in Reducing Health Inequalities

NCT04524286 | Completed

• 3 other identifiers: 19/20/IRAS/CC26236945534
• Study Type: observational
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

The impact of living in a deprived area has far reaching consequences on maternal and infant health. Studies in England show women living in deprived areas have some of the poorest experiences of care, poor birth outcomes and are 50% more likely to die of pregnancy related complications than women in the least deprived neighbourhoods. Life expectancy has also stalled for women living in the most deprived areas and the global COVID-19 pandemic has further amplified existing health inequalities. The Social Determinants of Health (SDH) are the conditions in which people are born, grow, work, live, and age, and are mostly responsible for health inequities - the unfair and avoidable differences in health seen within and between populations. Evidence shows taking action on the SDH alongside Midwifery Continuity of Care (MCC) models, improves birth outcomes and reduces health inequalities. How midwives working in MCC models in areas of high deprivation address the SDH as part of their public health and prevention role is currently not clear. There is also a lack of qualitative evidence exploring the SDH from the perspectives of women themselves. Drawing on Constructivist Grounded Theory methods, this research will take place in a low-income setting in England. Through the use of semi-structured interviews with women and midwives working in an NHS MCC model, the study will generate theory to help explain how and indeed whether midwives take action to address the SDH as part of their public health role. The study also seeks to understand the SDH impacting upon women's lives and what mechanisms exist to support or obstruct engagement with the SDH. Examining these domains will contribute to the evidence base about the impact of MCC and the public health and prevention strategy in NHS maternity services.

Conditions

Health Knowledge, Attitudes, Practice; Social Determinants; Public Health; Pregnancy Related

Keywords

Midwifery Continuity of Care; Social Determinants of Health; Childbearing women; Health inequalities/inequities; Constructivist Grounded Theory; Qualitative research

Outcome Measures

Primary Outcomes (4)

• Interviews with childbearing women

  Women living in the case setting willing to participate and share their maternity care experiences in one-to-one interviews.

  12 months

• Interviews with childbearing women

  Women living in the case setting willing to participate and share their childbearing experiences in one-to-one interviews.

  12 months

• Interview with midwives

  Midwives willing to participate and share their experiences of providing care to women in the case setting.

  12 months

• Interview with midwives

  Midwives willing to participate and share their knowledge about their public health role and how the actions they take to meet the needs of women.

  12 months

Secondary Outcomes (2)

• Document analysis

  12 months

• Memo writing

  12 months

Study Arms (2)

Public - Childbearing Women

Childbearing women living in three deprived areas in a city in the South of England.

Other: Interviews only.

Staff - Midwives

Midwives working in caseloading teams providing continuity of care to women living in three deprived areas in a city in the South of England.

Other: Interviews only.

Interventions

Interviews only. OTHER

Interviews will be conducted with childbearing women and midwives.

Public - Childbearing Women; Staff - Midwives

Eligibility Criteria

• Age: 16 Years - 50 Years
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

* Childbearing women - Women who receive their care from one of the MCC caseloading teams. In the context of this study the term 'childbearing woman' is defined as any woman of childbearing age over the age of 16 years who is currently pregnant or up to five years post childbirth; * Midwives - Midwives working in the study setting or have worked in one of the MCC caseloading teams. Also, midwives at the study site who have managerial and leadership oversight of the MCC teams.

You may qualify if:

• Women who are currently receiving maternity care from the MCC caseloading teams;
• Women who have previously received care from one of the caseloading teams;
• Women aged 16 and over;
• Women who can understand English and are able to independently provide their informed consent;
• Women at any point in their pregnancy or up to five years following the birth of their babies. This time frame is considered appropriate in order to capture women who are currently receiving maternity care and those who have received care locally in the last five years. This will aim to also capture women's experiences before referral to the caseloading teams changed;
• Women who had or are currently having their maternity care provided by UHS.
• Midwives who work in the MCC caseloading teams in the study setting;
• Midwives who have previously worked in the local MCC caseloading teams.
• Midwifery managers who have managerial oversight of the MCC caseloading teams.

You may not qualify if:

• Women who have not received care from one of the MCC caseloading teams;
• Women who gave birth more than five years ago;
• Women below the age of 16 years;
• Women who cannot speak English due to a lack of financial resources to fund translation services;
• Women who are in labour;
• Women who had their maternity care at a different NHS Trust;
• Women who lack capacity to provide informed consent;
• Women who decline to participate and decline to provide informed consent.
• Midwives who work in the universal teams;
• MSWs due to different professional roles and responsibilities;
• Midwives who decline to participate and decline to provide informed consent.

Sponsors & Collaborators

• Bournemouth University: lead
• University Hospital Southampton NHS Foundation Trust: collaborator

Study Sites (1)

Princess Anne Hospital - University Hospital Southampton

Southampton, United Kingdom

Location

MeSH Terms

Conditions

Behavior

Study Officials

• Charlotte Clayton

  Bournemouth University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: OTHER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 14, 2020
• First Posted: August 24, 2020
• Study Start: November 6, 2020
• Primary Completion: March 31, 2022
• Study Completion: March 31, 2022
• Last Updated: April 22, 2022

Record last verified: 2022-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF, CSR, ANALYTIC CODE
• Time Frame: After the study has ended and for 25 years after this.

Locations

GB (1)