HS&DR Project - 10/1009/24 Back
|Project title||Multi-site implementation of a promising innovation in low income communities: support for childbearing women|
|SDO research themes||Children / young people, Nursing and midwifery, Workforce|
|Chief investigator||Professor Helen Spiby, University of Nottingham|
|Co-investigators||Dr Shehzad Ali, Professor Josephine Green, Dr Helen Duncan, Dr Louise Girardier, Ms Jenny McLeish, Ms Julie Scarfe|
|Contractor||University of Nottingham|
|Start date||October 2011|
|Publication date||January 2014|
|Plain English summary|
Support and care in pregnancy, labour and after birth have a positive impact on womens wellbeing and outcomes including more normal births and increased breastfeeding rates. Such support and coordinated care is likely to be ...
Support and care in pregnancy, labour and after birth have a positive impact on womens wellbeing and outcomes including more normal births and increased breastfeeding rates. Such support and coordinated care is likely to be especially important in low income communities and for young women, as women in these circumstances are less likely to access routine services for themselves and their babies; have higher rates of smoking; lower rates of breastfeeding, increased rates of infant and maternal mortality, and problems with emotional and psychological wellbeing. A doula is a woman who provides continuous comfort, companionship and emotional support to a woman during pregnancy, labour and the period after birth. Studies of doula support from a number of other countries have now shown a range of benefits for both women and babies. These include less intervention during labour and fewer caesarean sections, more women starting and continuing breastfeeding, and increased use of services such as smoking cessation. Doula care is rare in the UK, especially for disadvantaged women, but is a promising innovation that could improve the health and wellbeing of disadvantaged mothers and babies. The Hull Goodwin Doula Project has been running for four years and aims to enhance disadvantaged womens use of existing health and social care services and to improve their own and their babies health and well-being. Early results are promising; if they are supported by independent research, and if rollout of the scheme in other areas with different populations can be achieved, the impact would be considerable. The DH has recognised the potential of this innovation by funding a package of support for replication sites. Sites still have to provide their own service support costs and just four sites have achieved this to date, despite high levels of interest. It will be important to understand the local circumstances which facilitate or hinder the use of promising new approaches to avoid duplication of effort in different NHS services and to obtain maximum learning from rollout into the replication sites.The proposed study meets the characteristics specified in the NIHR SDO programme call for research into promising innovations in healthcare demonstrable health benefits identified in high-quality researchthe innovation has been running in one centre in England for 4 years and has been well-received by women and well-integrated with health and other statutory servicesreplication sites have been identified and funding is available to support roll-outthe technology has been transferred from other countries, systems and settingsQ1: What are the implications for the NHS of a volunteer doula service for disadvantaged childbearing women?Q2: What are the health and psychosocial impacts for women? Q3: What are the impacts on doulas? Q4: What are the processes of implementing and sustaining a volunteer doula service for disadvantaged childbearing women?This research addresses a number of key health policy areas, including the need to reduce infant mortality and inequalities in health and care, improving the physical and emotional well-being of childbearing women, promoting normality in childbearing, improving the quality and productivity of maternity services, developing the workforce and examining large scale workforce change, reducing smoking, increasing breastfeeding rates and improving child health and development. Timetable and outputs:This is an 18 month project. The first five months will include induction of staff; updating the literature review; establishing linkages with sites and conducting the first round of interviews with managers and project workers [in Hull and the roll out sites], designing questionnaires and setting up systems for analysis of health and economic outcomes. Work will also include preparation of governance and Ethics submissions. Months 7-11 will be the main data collection period including women, doulas and NHS commissioners and staff in NHS Trusts. Analysis of questionnaire and interview data will commence in month 9 and be completed by month 16; synthesis and writing of the final report will follow. Outcomes used to assess the success of the research and associated time points include (end of months in parentheses): Linkages established with all sites: (2); Comparisons of health outcomes: analysis set up (4); final analysis run (5); Costs consequence analysis: set up (6) final analysis run (8); Ethics Committee approval obtained and portfolio registration achieved: (7); Interviews conducted: (11) (Heads of Midwifery; commissioners); Focus groups with midwives (11); Production of interim (7,13) and final reports (18), as required by the commissioner; feedback to sites (18); Publications in peer reviewed journals: after submission of final report; Conference presentations: June, September 2013The study will be carried out in Hull, Thurrock, Leeds, Bradford and Tower Hamlets where we have established support for the research. We will carry out interviews, either face-to-face or by phone, with a range of managers and commissioners in each site and we will gather the views and experiences of women and doulas using questionnaires, with follow-up interviews with a small number of doulas. Health outcomes for women receiving doula support in Hull will be compared with that of reference groups, using information available to the Public Health Observatory. The economic analysis will utilise this information in identifying both the costs of providing the doula service and potential NHS savings.Ethics: We will obtain Research Ethics Committee approval where necessary [prior to commencing data collection]. Participation will be voluntary and informed consent will be obtained. We do not anticipate that completion of questionnaires and participation in interviews or focus groups will cause distress to participants; however, we will identify potential sources of support in case that should occur. We would minimise inconvenience and demands on all participants and offer flexibility to support participation, for example, by conducting telephone interviews during the evening. We will work with particular awareness of the potential vulnerabilities of women in disadvantaged communities.
Conceptual framework: This study takes a Realistic Evaluation perspective in recognition of the complex intervention being investigated in a real-life setting. The focus is therefore not so much on addressing the question does ...
Conceptual framework: This study takes a Realistic Evaluation perspective in recognition of the complex intervention being investigated in a real-life setting. The focus is therefore not so much on addressing the question does it work? but rather what works for whom in what context?. Use of this framework is built upon theorised mechanisms of how and why the intervention is effective which are derived both from the literature and from key informants. The study will therefore start with an update of the literature based on the rapid review that we have already carried out and interviews with key informants.Sampling: There will be no sampling. All individuals meeting the criteria of the constituencies of research informants identified will be asked to participate.Setting/context: We will be working with five Volunteer Doula Services, all run by 3rd sector organisations, the original Hull Volunteer Doula Project and four roll out sites. All are focused on providing a service for disadvantaged childbearing women, particularly women from minority ethnic groups.Data collection and analysis: Data addressing the four main research questions will be collected from the following sources and is described in greater detail in the Detailed Project Plan:Q1: What are the implications for the NHS of a volunteer doula service for disadvantaged childbearing women?1. The records of the Hull Goodwin Doula Project. Records of obstetric and other health outcomes for women, as well as process data, have been gathered over the years by the Hull Goodwin Doula Project in a bespoke database. Data will be compared with selected population reference groups allowing an estimate of the impact for the NHS at scale, including a health economic analysis. (See Detailed Project Plan).2. One off telephone interviews with Heads of Midwifery in each site3. Focus groups with midwives in each site Q2: What are the health and psychosocial impacts for disadvantaged childbearing women? 4. A retrospective survey of all women who have been referred to the service (all sites, women to be accessed via the services records)5. The records of the Hull Goodwin Doula Project and the four roll out sites, as above. The database is part of the roll out package, so the expectation is that the roll out sites will be collecting the same data. Q3: What are the impacts on volunteer doulas? 6. A focus group with 6-10 experienced volunteer doulas in Hull early in the project7. A survey of all volunteers who have been trained by the service (all sites, to be accessed via the services records) Q4: What are the processes of implementing and sustaining a volunteer doula service for disadvantaged childbearing women?8. Focus groups with Locality Development workers (or equivalent) in each site. These are the social enterprise employees who facilitate the service, e.g. by matching doulas with referrals. In the roll out sites, these will be repeated after 11 months to assess change.9. Interviews with project managers in each site. In the roll out sites, these will be repeated after 11 months to assess change. 10. Interviews with local champions ie the people who have been instrumental in championing the service in the roll out sites11. Interviews with commissioners in each of the roll out sites.In addition, it is expected that the interviews and focus groups with all other staff and doulas in the rollout sites (sources 2-8 above) will also contribute towards addressing this question.Data from the service database: Data from the bespoke database will give descriptive information on outcomes since 2007. It will be possible to examine trends over time, for example of the numbers of women being referred and their characteristics as well as their outcomes. Although the study design precludes any direct comparison group (as explained in the following section) we will be collecting data in a form that will allow multiple comparison reference groups. These will allow us to compare the results for women in our study with comparable data for certain clinical and psychosocial outcomes including health behaviours such as smoking and breastfeeding.Reference Group 1: Hospital Episode Statistics and PCT data1) Detailed analysis of Hospital Episode Statistics and PCT data will be undertaken by analysts at the national Public Health Observatory for Children and Maternity (ChiMat, http://www.chimat.org.uk/) led by co-applicant Helen Duncan. These data sources will allow us to look at mode of birth, birthweight, breastfeeding initiation, breastfeeding at 6-8weeks and smoking by a number of demographic factors e.g. age and ethnic group of mother, economic hardship of mother based on index of multiple deprivation. We will then be able to look at outcomes for demographically comparable subsamples within (i) the general Hull PCT population, (ii) the designated statistical neighbours for Hull and (iii) England averages. A linked cost-consequences analysis will then be undertaken by health economist co-applicant Shehzad Ali.Reference Group 2: Millennium Cohort StudyMany of the outcomes that we will assess were also used in the Millennium Cohort Study (MCS). The size of the MCS dataset is such that it will be possible to look at outcomes for subgroups with demographic characteristics that match those of women in our study, thus providing an additional reference group for a range of clinical and psychosocial outcomes. Reference Group 3: The Family Nurse Partnership (FNP) Evaluation TrialA randomised controlled trial of the Family Nurse Partnership (FNP) is currently ongoing in 19 sites in England, all of which have high levels of deprivation. Our psychosocial outcome measures will, as far as possible, be based on those used in the FNP trial to allow comparison once the FNP data are released.
|Outputs||no published journal articles or book outputs notified|
|Commissioning brief||Download (PDF 67Kb)|
|Protocol||Download (PDF 386Kb)|
|Addendum||This project was commissioned by the NIHR Service Delivery and Organisation (NIHR SDO) programme under the management of the National Institute for Health Research Evaluations, Trials and Studies Coordinating Centre (NETSCC) based at the University of Southampton.|