POPPIE: implementation of a randomised controlled trial of midwifery continuity of care for women at risk of preterm birth

Topic area Increasing continuity of midwife care has been identified as a key priority for maternity services in the UK (1). A Cochrane review found that women who receive care by one named midwife or a small group of... [ view full abstract ]

Topic area

Increasing continuity of midwife care has been identified as a key priority for maternity services in the UK (1). A Cochrane review found that women who receive care by one named midwife or a small group of midwives throughout pregnancy, birth and postnatal periods are 24% less likely to experience a preterm birth and more likely to have better maternal and infant outcomes, have more positive experiences of care (2). This is particularly important considering increasing rates of preterm births worldwide and their adverse infant outcomes in terms of survival, quality of life, psychosocial impact on the family and costs to society (3). POPPIE is a hybrid-effectiveness trial which aims to implement and test the impact of a care pathway which combines midwife continuity of care with rapid referral to a specialist obstetric clinic throughout pregnancy through to the postpartum period for women who are at risk of preterm birth (4).

Theoretical perspective

We describe key implementation strategies, stakeholder analysis and the development of a logic model to conceptualise the relationship between context, process and outcomes. The Consolidated Framework for Implementation Research (CFIR) is used to identify and describe contextual factors that may affect implementation success. Based on these contextual factors, we have selected implementation strategies and outcomes. A process evaluation of the intervention implementation is being carried out to understand variations in the impact of the intervention, and contextualise findings.

Discussion

We discuss how we are exploring the mechanism and relationship between our intervention, how it is implemented, mechanism of action and process, clinical and psycho-social outcomes.

Conclusion

Using POPPIE as an exemplar, we will be able to unpack the ‘black box’ of understanding the implementation of complex interventions. It will also help us to understand mechanisms of impact on maternal physical, psychosocial, neonatal health, and women’s experiences of care, quality of care and resource use.

References:

1. NHS England National Maternity Review Team (2016) Better Births, Improving outcomes of maternity services in England – A five year forward view for maternity care. Available from: https://www.england.nhs.uk/our... (Accessed 2^nd September 2017

2. Sandall J, Soltani H, Gates S, Shennan A, Devane D. (2016) Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 9:CD004667

3. The Lancet (2016) The unfinished agenda of preterm births. The Lancet. Vol.338(10058): 2323.

4. Fernandez Turienzo C, Sandall J, and Peacock JL (2016) Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis. BMJ Open. Vol. 6(1): e009044

5. Sandall J, Coxon, K., Mackintosh, N., Rayment-Jones, H., Locock, L. and Page, L. (2016) Relationships: the pathway to safe, high-quality maternity care, Report from the Sheila Kitzinger symposium at Green Templeton College October 2015. Oxford: Green Templeton College.