Title: ARM@DA: A Realist Inquiry into Maternity Care @ a DistAnce
Funder: Department of Health and Social Care

Abstract: WHY ARE WE DOING THIS PROJECT?_x000D_ _x000D_ There are lots of changes going on in maternity care services in England to make them safer, kinder, more person-centred and more family friendly. One area of change is around digital technology and how it can be used to improve care. During the Covid-19 pandemic, many maternity services shifted their appointments and contacts from face to face to non-face to face by using digital technology such as telephone calls, text messages or video calls. These remote maternity contacts include antenatal and postnatal appointments and visits, calls during labour and any aspect of maternity care or services that is not provided face to face. Remote contacts can have advantages and disadvantages - depending on women’s needs, situation, stage of pregnancy and how easy the technology is to use. In addition, it is important that services are accessible to everyone, including people from ethnic minority groups and disadvantaged groups. _x000D_ _x000D_ Maternity services are now considering whether and how to continue using digital technology for maternity contacts. It is vital that future services are based on a good understanding of women’s and health professionals’ experiences of remotely delivered care. _x000D_ _x000D_ AIM OF THE RESEARCH_x000D_ _x000D_ The aim of this project is to help to decide when, how and for whom non-face to face contacts can safely be used in maternity care. _x000D_ _x000D_ WHO IS DOING THE RESEARCH?_x000D_ _x000D_ The research team includes an experienced group of midwives, service users, doctors and researchers. In addition, the project will involve, and be guided by, two expert stakeholder groups. One stakeholder group has representatives from community organisations, service users and public involvement networks that represent a very wide range of women with different needs and experiences. The other stakeholder group will represent a range of NHS maternity staff. The research team will also be guided by a Project Advisory Group (made up of senior maternity staff, commissioners and policy makers). _x000D_ _x000D_ WHAT WILL THE STUDY INVOLVE?_x000D_ _x000D_ The project will take 18 months. We will find and analyse all research studies on remotely delivered maternity care. We will also get ideas and insights from the two expert stakeholder groups. We will identify, test and refine theories that may explain when, how and for whom non face to face contacts should best be used. If we cannot find all the evidence we need to fully understand a theory, we may also interview a small number of women and health professionals to get a better picture. We will use the information from these different sources to create a framework for best practice to guide maternity services for all families. _x000D_ _x000D_ HOW WILL THE RESEARCH FINDINGS MAKE A DIFFERENCE?_x000D_ _x000D_ The project will provide important guidance on how best to use non-face to face contacts in maternity care. It will also identify any areas that need more research and will show where healthcare professionals need further training. We will share our findings widely with those who provide and use maternity services. We will do this using social media, infographics, webinars, conferences, best practice guides and papers in journals for practitioners and researchers. We will also use the project findings to create an e-learning resource for health professionals.

Lay abstract: BACKGROUND_x000D_ _x000D_ 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. _x000D_ _x000D_ RESEARCH AIM_x000D_ _x000D_ 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. _x000D_ _x000D_ RESEARCH DESIGN AND METHODS_x000D_ _x000D_ 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. _x000D_ _x000D_ RESEARCH TEAM_x000D_ _x000D_ 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._x000D_ _x000D_ DISSEMINATION AND IMPACT_x000D_ _x000D_ 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.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH