Using a Midwifery Quality Care Framework to Explore the Use of Communication Technology Between LMC Midwives and Pregnant Women/People in Aotearoa New Zealand: A Mixed Method Approach.

Abstract

This PhD thesis aimed to explore how communication technology is used between Lead Maternity Carer midwives and pregnant women/people in Aotearoa New Zealand, and how this contributes towards quality maternal and newborn care. A mixed method multi-phase sequential transformative design is used, using the quality maternal and newborn care (QMNC) framework developed by leading international midwifery researchers. This PhD thesis has been undertaken with publication and consists of ten chapters which include six published papers, one paper accepted for publication, and two papers under review for publication.

The first publication is an integrative literature review which involved systematically reviewing a variety of research methodologies to explore how communication technology enabled midwives and pregnant women/people to connect. The findings were mapped onto categories from the QMNC framework, which then informed questions for the online surveys.

In the second publication, an expert advisory group of midwifery academic researchers experienced in both quantitative and qualitative research were asked to assess the reliability and validity of questions for use in online surveys. Analysis was undertaken using content validity index and Cronbach’s alpha coefficient. Further consideration was also given to qualitative comments provided by the group. This provided reassurance to move to phase one of data collection.

In phase one, data was collected from LMC midwives and pregnant women/people with findings presented as publications in chapters five and six. The findings indicated that phone calls, texting and emails were commonly used by LMC midwives to reinforce health messages and decision making. Texting was beneficial in aiding documentation and enabled midwives to work efficiently. However, concerns were identified when managing expectations around urgent and non-urgent communication.

For pregnant women/people, texting was the most common form of communication technology used, while technologies associated with social media were seldom used by pregnant people or midwives. Privacy and confidentiality of information was not a concern for pregnant women/people with 79% of pregnant people not using security measures on their devices.

In phase 2, online semi-structured interviews were conducted with LMC midwives (2A) and pregnant women/people (2B). In the fifth publication, insights are offered around the valuable contribution that online interviewing can offer as a valid research tool that differs to that of in-person face-to-face interviews.

Three themes were identified from interviews with midwives. In theme one, communication technology was found to enable midwives and pregnant women/people to connect through having space and distance to consider and respond to messages. In theme two, continuity of care gave midwives a ‘knowingness’ of their clients which enabled them to negotiate safe and appropriate means for contact and to develop strategies to ensure access and connection. In the final theme, midwives were balancing the convenience of the technology with the relationship they develop with their pregnant clients, while ensuring privacy and confidentiality of information, and maintaining their own work/life balance.

Three themes were identified from interviews with pregnant women/people. The importance of being known within a continuity of care relationship, reassurance that was provided through the flexibility and convenience of the technology and the professionalism of the midwife that instilled trust with the way the midwife used technology to respond.

Communication technology when used within a model of continuity of care, was found to compliment the relationship that is developed between LMC midwives and pregnant women/people. While more work is needed with managing the divide between societal and regulatory body expectations, communication technology provided solutions for midwives in creating a more sustainable work/life balance which is crucial for the sustainability of midwifery practice.