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Dickinson, Fiona 
ORCID: https://orcid.org/0000-0002-5298-9127
(2020)
Development of a Patient Reported Outcome Measure to Assess Quality of Care in Maternity Services in Low and Middle-Income Countries, Thesis (Doctoral), Liverpool School of Tropical Medicine.
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F Dickinson - Final PhD thesis.pdf - Accepted Version Download (8MB) | Preview |
Abstract
Background: Patient Reported Outcome Measures (PROMs) are questionnaires used for collecting data on health outcomes from patients. They have been used for multiple purposes including standardising research outcomes, clinical patient monitoring, promoting patient choice and assessing quality of care (QoC). Globally, low and middle-income countries (LMICs) bear the highest burden of preventable maternal and newborn mortality and morbidity. In order to reduce these high levels, poor quality care needs to be addressed. This study aimed to identify and develop, if required, a PROM suitable for assessing QoC in maternity services in LMICs, to enable the targeting of quality improvement activities.
Methods: An initial systematic review found no suitable existing PROM for assessing QoC in maternity services, so a second review was carried out to identify current practice in developing a new PROM. Semi-structured interviews and focus group discussions were conducted with women who had recently given birth in healthcare facilities in Malawi and Kenya. The recordings from these interviews and discussion groups were transcribed, coded and analysed using a thematic approach. From the data, draft outcomes were identified, and following review by experienced clinicians, the draft Maternity Patient Reported Outcome Measure (MPROM) was developed. A small group of new mothers in both countries were asked to evaluate the draft PROM using cognitive debriefing methods, resulting in the final proposed MPROM.
Results: In all, 38 interviews and six focus groups were conducted in Malawi (total 72 participants) and 45 interviews and four focus groups were conducted in Kenya (total 65 participants). A range of potential outcomes were identified including common physical and psychological symptoms, a variety of social issues impacting on the mother’s health, and physical health outcomes relating to the baby. These were formatted into a draft version of the maternity PROM (MPROM) comprising 81 questions, which was reviewed by nine women who had recently given birth, and amendments made based on their recommendations.
Conclusion: Following extensive input by women from the target population, as well as clinical experts and available literature, this study developed the first condition-specific PROM suitable for assessing QoC in maternity services in LMIC. Further research will be needed to assess its psychometric properties, prior to deployment in healthcare facilities as a means of facilitating improvements in the quality of care, and ultimately reducing maternal and newborn mortality and morbidity. The MPROM may also be deployed in other countries following appropriate validation.
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