Outcome measurement in surveys of women’s experiences

of maternity care

Josephine GreenMother and Infant Research Unit (MIRU)

Department of Health Sciences, University of York, UK

1987

1991

2000

Great Expectations 2 antenatal q’res, 1 postnatal, 6 maternity units, N=825

Cambridge Prenatal Screening Study 3 antenatal q’res, 1 postnatal, 9 maternity units, N=1824

Greater Expectations? Re-study of Great Ex. 8 maternity units, N=1432

Follow up of women from Greater Ex 3 years later, N=738 (Baston PhD thesis)

2003

Dutch ‘replication’ of G’r Ex follow up. 8 primary care midwifery practices, N=13102004

Joint analysis of data from KUB in Sweden and Greater Ex

2008

ESMEE• European Survey of Maternity

Expectations & Experiences• Nine participating countries in

Northern and Central Europe• Funding applications to the

European Collaborative Research Partnership (2009, 2010)

MOTHER & INFANT RESEARCH

UNIT

Choosing outcomes: principles• Know what the question is that you want to

answer• Relate the outcomes you measure to your model

(assumptions) about how things work• Measure at the right time• ‘Validated’ doesn’t necessarily make it valid for

your circumstances – E.g. not valid for this population– Measuring the wrong thing– How/when administered

Satisfaction

• Specific is better than global

• May be better to avoid the word satisfaction altogether

• Any expression of dissatisfaction is significant (van Teijlingen et al 2003)

• Continuum from ‘Satisfied’ to ‘Very Satisfied’ Collins & O’Cathain (2003)

• “Did the right thing happen?”

Interpersonal interactions

• Do you feel that you were treated as an individual?– yes, always– yes, by most of the staff– only by a few of the staff– no, not at all

 

• Do you feel that you were treated with respect?

Other ways of asking (1)

• Adjective checklists

overwhelmed calm confident

excited out of control dopey

frightened involved powerless

detached in control challenged

powerful alert helpless

Green et al 1990

Other ways of asking (2)

• The Cambridge Worry Scale (Green et al 2003)– Potential worries determined by qualitative

work with the target group– Now been used in a number of countries (incl.

Greece right now)

• Andrew Symon’s Mother Generated Index (2002, 2003 onwards)

MOTHER & INFANT RESEARCH

UNIT

A comparison of Swedish and English primiparae’s experiences of birth

Josephine Green & Helen Baston Mother & Infant Research Unit, Department of Health Sciences, University of

York, UK

Erica Schytt & Ulla WaldenströmCenter for Clinical Research Dalarna, Sweden &

Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden

Schytt et al (2008) Journal of Reproductive & Infant Psychology, 26(4), 277-294

Background• Plans for an international comparative study of

women’s experiences of childbirth (ESMEE)– To what extent can we answer comparative

questions through secondary analysis of existing data?

• Special issue of Journal of Reproductive & Infant Psychology “Cross-national comparisons of psychosocial aspects of childbirth” (November 2008)

MOTHER & INFANT RESEARCH

UNIT

78.570.1

57.9

7.5 7.316.3

28.9 24.9

57

23.6

0

20

40

60

80

100

KUB

G'r Ex

Words used to describe self in labour