MIDWIZE - Strengthening Midwives to Implement and Sustain Quality Improvements to Optimise Maternity Care: A Longitudinal Observational Study in Uganda
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 1,000
- 试验地点
- 4
- 主要终点
- Postpartum haemorrhage
研究概览
简要总结
This PhD project aims to explore how midwives can take the lead in implementing and enhancing evidence-based quality improvement (QI) components within maternal and newborn health care in Uganda.
The MIDWIZE conceptual framework will be used to understand the complexity of sustainably enhancing maternal and newborn healthcare. The project will start with a multisectoral co-creation process and subsequently involve online and onsite capacity building for midwives on selected evidence-based practices and implementation strategies. The project applies a mixed-method research approach, including focus groups discussions, interviews, quantitative data on health outcomes and a tool evaluating midwives' sense of power and autonomy.
详细描述
Traditionally, Quality Improvement (QI) initiatives in healthcare have often centered on the implementer's viewpoint, neglecting the active involvement of staff in shaping or leading interventions, or viewing them merely as passive objects resistant to change. Previous research in QI and organizational development indicates that when individuals or teams identify and take ownership of problems, the resulting actions are more effective and sustainable, as opposed to when solutions are imposed externally. Thus, our hypothesis was that by empowering midwives to spearhead change initiatives, involving them in the co-creation of interventions to ensure relevance and ownership, and equipping them with QI leadership and practical skills, midwives would effectively enhance healthcare service quality, foster the adoption of evidence-based practices, and ultimately improve health outcomes for women and newborns.
MIDWIZE is a model based on multisectoral collaboration to enhance evidence-based practices through Midwife-Led Care (MLC) and interdisciplinary teamwork.
Focusing on midwives as the primary health care providers at all levels of a country's maternal and reproductive health care system is an elementary part of the MIDWIZE model. Utilising midwives' potential through MLC facilitates relational, safe, cost-effective, and patient-centred care.
When additional support is required, the MLC needs to be provided in an environment that successfully takes advantage of different clinical professions' competencies. Working towards shared goals and having a clear understanding of each team member's responsibilities in an interdisciplinary team are central factors for utilising human and financial resources.
At the heart of the MIDWIZE model is enhancing the use of evidence-based practices and international guidelines for maternal and newborn health care - focusing on a healthy mother, a healthy child, a positive birth experience, and respectful care. The Z in MIDWIZE stands for the importance of "Zero separation" between the mother/birthing parent/caregiver and newborn in the early postpartum period - an evidence-based practice enhancing neonatal health outcomes, breastfeeding, and the bonding between mother/birthing parent/caregiver and child.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •People above the age of 18 with uncomplicated singleton full-term pregnancies and births (i.e. between weeks 37 + 0 - 42 + 0).
排除标准
- •People under the age of 18, people with complications in pregnancy or with a planned c-section.
结局指标
主要结局
Postpartum haemorrhage
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Postpartum haemorrhage
The uptake of the midwives quality improvments
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Three evidence based midiwfery practises (i) dynamic birth positions, (ii) intrapartum support and (iii) prevetion of perineal tears .
Perineal tear
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Perineal tear (divided in unsutured tear, sutured tear, sphinkter tear)
Apgar score
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Apgar score. The Apgar score is a rapid assessment of a newborn's health, conducted one minute and five minutes after birth, evaluating their heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each component is scored from 0 to 2 points, with a maximum score of 10 points.
Episiotomy
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Was episiotomy performed at birth
Neonatal and maternal deaths
时间窗: Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.
Neonatal and maternal deaths
次要结局
- Marital status(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Gestation week(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Mode of delivery(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Area of living(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Level of education(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Mothers age(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Employment(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Obstetric background(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.6months after implementation phase is completed.)
- Length of second stage of labour(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Birth weight(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Transfer to a neonatal unit(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
- Skin-to-skin care(Through study completion, an average of 6 months and a follow up period (2 weeks) after 3 and 6months after implementation phase is completed.)
研究者
Helena Lindgren
Professor
Karolinska Institutet