Outcome measurement in surveys of women’s experiences of maternity care Josephine Green Mother and Infant Research Unit (MIRU) Department of Health Sciences, University of York, UK

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= 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) M OTHER & I NFANT R ESEARCH U NIT

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 overwhelmedcalmconfident excitedout of controldopey frightenedinvolvedpowerless detachedin controlchallenged powerfulalerthelpless 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)

M OTHER & I NFANT R ESEARCH U NIT 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 Waldenström Center 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),

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) M OTHER & I NFANT R ESEARCH U NIT

Words used to describe self in labour