ARM@DA: A Realist Inquiry into Maternity Care @ a DistAnce

BACKGROUND

The Maternity Transformation Programme in England aims to create safer, kinder, more personalised and family friendly care. A core work stream is ‘harnessing digital technology’. The Covid-19 pandemic has radically altered and dramatically accelerated the context for this digital policy imperative.

One of the most commonly reported Covid-related changes to all maternity services has been an increase in the use of remote/virtual consultations using telephone or video-calling. This shift was primarily implemented to support pandemic response objectives such as social distancing and service demand management. Going forward however, a key service challenge lies in how to ‘re-purpose’ the use of digital clinical consultations to meet longer term quality, equity and productivity objectives.

National guidance has been developed quickly to guide professional practice, but there has not, to date, been a comprehensive review of the evidence base to inform future service developments or research in this area of maternity care. Hence, although remote consultations may now be widespread, the ways in which they can be optimally scaled up and utilised in future along the maternity care pathway is unclear.

This proposed project seeks to fill these gaps through an in-depth and theory-informed investigation of the evidence around implementation of digital clinical consultations. RESEARCH AIM

To identify mechanisms to explain how digital consultations can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts. RESEARCH DESIGN AND METHODS

A realist synthesis will be conducted over an 18-month period in 4 highly iterative phases: (i) refining the review focus and generating initial programme theories, (ii) exploring and developing the programme theories in light of evidence, (iii) testing/refining the programme theories, and, (iv) constructing actionable recommendations in ways that can be rapidly adopted into practice and clearly define a future research agenda. The review will draw upon three sources of evidence: (i) literature (published and unpublished research, audit, evaluation and theory), (ii) stakeholder expertise and insights, and (iii) (limited) key informant interviews.

The review will be registered on Prospero and will follow the RAMESES (Realist and Meta-narrative Evidence Synthesis Evolving Standards) quality procedures and will comply with RAMESES reporting guidance. RESEARCH TEAM

The project includes extensive PPI at every stage. It includes a highly experienced multi-professional and multi-disciplinary team of academics, information scientists, service users and expert clinicians. This group will work closely alongside two expert stakeholder groups (NHS staff and community organisations/service users) designed to reflect a wide diversity of experience.

DISSEMINATION AND IMPACT

The review findings will be disseminated in formats relevant to different audiences, augmented and signposted through social media, including reports/publications, webinars, best practice infographics and implementation toolkits and an online education resource. The review output will be a theoretically-grounded explanatory framework for safe, appropriate and acceptable digital consultations in maternity care that can be used by NHS stakeholders to guide future service development, policy, practice and research.