Implementation and evaluation of a complex intervention within a community programme: The example of a midwifery continuity of care model.
PHE ePoster Library. Dharni N. Sep 10, 2018; 221354; 78
Dr. Nimarta Dharni
Dr. Nimarta Dharni
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Abstract
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Abstract Background Better Start Bradford (BSB) is implementing numerous interventions to improve the health and wellbeing of children aged 0-3 years. Born in Bradford (BiB) is working in partnership with BSB to evaluate these interventions. BiB have developed a pragmatic approach to evaluation to provide much needed evidence in public health, and present a worked example from the evaluation of an adapted midwifery continuity of care model. Methods Implementation evaluation was completed using a mixed methods approach underpinned by Hasson's (2010) conceptual framework for implementation fidelity. A feasibility effectiveness evaluation was completed using routine data from the Born in Bradford's Better Start experimental birth cohort, analysed using quasi-experimental methods. Results A continuity of care model was feasible to implement within BSB. Manageable caseloads and extended appointment times increased team stability, and flexible working patterns facilitated care and job satisfaction in midwives. For mothers, continuity was integral to building trust with their midwife, encouraged disclosure of mental health issues and increased confidence in making birth choices. The feasibility effectiveness evaluation showed trends towards positive outcomes for women receiving continuity of care. Conclusion The current evaluation highlighted many benefits of a continuity of care model for midwives and mothers. Such in-depth findings were only possible through this rigorous, pragmatic, mixed methods approach. External funding details This study has received funding through a peer review process from the Big Lottery Fund as part of the A Better Start programme. The Big Lottery Fund have not had any involvement in the design or writing of the study protocol.
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