Purpose of the PSP and background
The purpose of this protocol is to clearly set out the aims, objectives and commitments of the midwifery practice and maternity care Priority Setting Partnership (PSP) in line with James Lind Alliance (JLA) principles. The Protocol is a JLA requirement and will be published on the PSP’s page of the JLA website. The Steering Group will review the Protocol regularly and any updated version will be sent to the JLA.
The JLA is a non-profit making initiative, established in 2004. It brings patients, carers and clinicians together in PSPs. These PSPs identify and prioritise the evidence uncertainties, or ‘unanswered questions’, that they agree are the most important for research in their topic area. Traditionally PSPs have focused on uncertainties about the effects of treatments, but some PSPs, such as this one, have chosen to broaden their scope beyond that. The aim of a PSP is to help ensure that those who fund health research are aware of what really matters to patients, carers and clinicians. The National Institute for Health and Care Research (NIHR) coordinates the infrastructure of the JLA to oversee the processes for PSPs, based at the NIHR Coordinating Centre (NIHRCC), University of Southampton.
The rationale behind the RCM leading this project is to:
- Influence funding bodies, such as the NIHR, to fund more midwifery and maternity research
- Influence policy makers about relevant gaps in evidence
- Build networks within maternity healthcare
- Encourage midwives to take part in a consensus building exercise with a research focus
- Support midwifery researchers to identify topics, including those applying to the RCM Wellbeing of Women award and the Iolanthe Trust Jean Davies award
It forms the last major project of the current RCM Research and Development strategy.
Several maternity research prioritisation projects have previously been undertaken in the UK. Cheyne et al (2012) investigated the research priorities of Scottish women. In this study, focus groups were held to develop the comprehensive list which included a final ‘top ten’ list of priority topics. Other work includes the RAND report (Guthrie et al 2020) commissioned by the UK Clinical Research Collaboration and funded by National Institute for Health and Care Research (NIHR) and the Wellcome Trust. This work included a prioritisation exercise spanning the whole of pregnancy research and was intended to provide a picture of the key topics of importance to different stakeholders, including researchers, healthcare professionals, charities, funders and members of the public (Guthrie et al 2020).
The Research Team decided to add an additional layer to the JLA PSP, a Review Group made up of three eminent midwifery professors: Professor Helen Cheyne of the University of Stirling, Professor Vanora Hundley of Bournemouth University and Professor Julia Sanders of Cardiff University. The Review Group provides academic rigour and guidance to the team and have been meeting to support the RCM Research Team prior to the engagement of the JLA.
Aims, objectives and scope
The aim of the midwifery practice and maternity care PSP is to identify the unanswered questions about all areas or aspects of midwifery practice and agree which are the most important for research to address.
The objectives of the PSP are to:
- work with women and birthing people, and their families and friends, service user organisations, midwives and MSWs to identify uncertainties about midwifery practice and maternity care
- to agree, by consensus, a prioritised list of those uncertainties for research
- to publicise the results of the PSP and process
- to take the results to research commissioning bodies to be considered for funding.
The scope of this PSP will include:
- Perspectives gathered from all four countries of the UK.
- Perspectives from:
- Midwives (regardless of current professional focus), student midwives and maternity support workers
- Service users – which include women and birthing people, their partners, families and friends
- Service user organisations
- Perspectives about:
- Midwifery care and practice - this also includes the role and activities undertaken by maternity support workers. The PSP will exclude from its scope questions which are outside the midwifery scope of practice, as defined by the Nursing and Midwifery Council in its Standards of Proficiency for Midwives.
- Education and development
- Workforce and staff wellbeing
- Any other sphere of midwifery practice
The Steering Group is responsible for discussing what implications the scope of the PSP will have for the evidence-checking stage of the process. Resources and expertise will be put in place to do this evidence checking.
The Steering Group
The Steering Group membership includes women and birthing people, as individuals or as representatives from relevant organisations, midwives, a student midwife and maternity support workers. The midwives bring with them their varied backgrounds and experiences across clinical, leadership, education and research roles.
The membership of the Steering Group
Service users and service user organisation representatives
- Abi Gay, service user
- Nadia Higson, AIMS
- Katherine Letley and Mel Cooper (job share), Maternity Stream City of Sanctuary
- Amber Marshall, Big Birthas
- Laura-Rose Thorogood, LGBT Mummies
Midwifery and MSW representatives
- Laura Abbot, midwife, England
- Claire Bertorelli, midwife, Wales
- Racheal Crane, maternity support worker, England
- Sarah Esegbona-Adeigbe, midwife, England
- Christine Furber, midwife, England
- Melanie Harrington, student midwife, Northern Ireland
- Stephanie Heys, midwife, England
- Emma Lesley, maternity support worker, England
- Tom McEwan, midwife, Scotland
- Jenny McNeill, midwife, Northern Ireland
- Sian Rogers, midwife, England
Project coordinators
Co-leads: Dr Jude Field and Jenny Cunningham
Support for co-leads: Dr Sara Webb and Dr Yana Richens
James Lind Alliance Adviser and Chair of the Steering Group: Dr Nahid Ahmad
Information specialist: Louise Deighton-O’Hara
The Steering Group will agree the resources, including time and expertise that they will be able to contribute to each stage of the process, with input and advice from the JLA.
Partners
Organisations and individuals will be invited to be involved with the PSP. Project Partners are organisations or groups who will commit to supporting the PSP, promoting the process and encouraging their represented groups or members to participate. Organisations which can reach and advocate for these groups will be invited to become involved in the PSP. Partners represent the following groups:
- Women and birthing people
- Families and friends of women and birthing people
- Midwives, student midwives and maternity support workers
Project Partners will be listed on the RCM website.
Individuals can receive the surveys direct to their email inbox by becoming Interested Parties.
Exclusion criteria
Some organisations may be judged by the JLA or the Steering Group to have conflicts of interest. These may be perceived to potentially cause unacceptable bias as a member of the Steering Group. As this is likely to affect the ultimate findings of the PSP, those organisations will not be invited to participate. It is possible, however, that interested parties may participate in a purely observational capacity when the Steering Group considers it may be helpful.
The methods the PSP will use
This section describes a schedule of proposed steps through which the PSP aims to meet its objectives. The process is iterative and dependent on the active participation and contribution of different groups. The methods used in any step will be agreed through consultation between the Steering Group members, guided by the PSP’s aims and objectives. More details of the method are in the Guidebook section of the JLA website where examples of the work of other JLA PSPs can be seen.
Step 1: Identification and invitation of potential partners
Potential partner organisations will be identified through a process of open invitation and reaching out through existing networks. Potential partners will be contacted and informed of the establishment and aims of the midwifery and maternity PSP and invited to become formally involved. Registration will be open throughout the life of the project.
Step 2: Awareness raising
PSPs will need to raise awareness of their proposed activity among their midwifery practice and maternity care communities, in order to secure support and participation. Awareness raising has several key objectives:
- to present the proposed plan for the PSP
- to generate support for the process
- to encourage participation in the process
- to initiate discussion, answer questions and address concerns.
The Steering Group members will be involved in awareness raising within and beyond their own organisations.
Step 3: Identifying evidence uncertainties
The midwifery practice and maternity care PSP will carry out a consultation to gather uncertainties from survey respondents. A period of 13 months will be given to complete this exercise (which may be revised by the Steering Group if required).
The midwifery practice and maternity care PSP recognises that some groups may require additional consideration, such as women who do not have English language proficiency. The Steering Group should consider the nature of the groups that it is targeting, their needs and how to reach potentially seldom heard or marginalised communities.
The Steering Group will discuss and decide which methods can be used to reach the target groups. The Steering Group and Project Partners will advise and agree on the best methods for dissemination for reaching all relevant groups and individuals.
Existing sources of evidence uncertainties will also be searched, including Cochrane reviews and NICE and SIGN guidelines. The Review Group will be updated and consulted during step 3.
Step 4: Refining questions and uncertainties
The consultation process will produce ‘raw’ questions and comments indicating survey respondents’ areas of uncertainty. These raw questions will be categorised and refined into summary questions which are clear, addressable by research, and understandable to all. Similar or duplicate questions will be combined where appropriate. Out-of-scope and ‘answered’ submissions will be compiled separately. The Steering Group will have oversight of this process to ensure that the raw data is being interpreted appropriately and that the summary questions are being worded in a way that is understandable to all audiences. The JLA Adviser will observe to ensure accountability and transparency.
This will result in a long list of in-scope summary questions. These are not research questions and to try and word them as such may make them too technical for a non-research audience. They will be framed as researchable questions that capture the themes and topics that people have suggested.
The summary questions will then be checked against evidence to determine whether they have already been answered by research. This will be done with the assistance of a librarian from MIDIRS. The PSP will complete the JLA Question Verification Form, which clearly describes the process used to verify the uncertainty of the questions, before starting prioritisation. The Question Verification Form includes details of the types and sources of evidence used to check uncertainty. The Question Verification Form should be published on the JLA website as soon as it has been agreed to enable researchers and other stakeholders to understand how the PSP has decided that its questions are unanswered, and any limitations of this.
Questions that are not adequately addressed by previous research will be collated and recorded on a standard JLA template. This will show the checking undertaken to make sure that the uncertainties have not already been answered. The data should be submitted to the JLA for publication on its website on completion of the priority setting exercise, taking into account any changes made at the final workshop, in order to ensure that PSP results are publicly available.
The Steering Group will also consider how it will deal with submitted questions that have been answered, and questions that are out of scope. The Review Group will be updated and consulted during step 4.
Step 5: Prioritisation – interim and final stages
The aim of the final stage of the priority setting process is to prioritise through consensus the identified uncertainties about midwifery practice and maternity care. The JLA encourages PSPs to involve as wide a range of people as possible, including those who did and did not contribute to the first consultation. There are usually two stages of prioritisation.
- Interim prioritisation is the stage where the long list of questions is reduced to a shorter list that can be taken to the final priority setting workshop. This is aimed at a wide audience, and is done using similar methods to the first consultation. With the JLA’s guidance, the Steering Group will agree the method and consider how best to reach and engage potential survey respondents in the process. The most highly ranked questions (around 25) will be taken to a final priority setting workshop. Where the interim prioritisation does not produce a clear ranking or cut off point, the Steering Group will decide which questions are taken forwards to the final prioritisation.
- The final priority setting stage is generally a one-day workshop facilitated by the JLA. With guidance from the JLA and input from the Steering Group, around 30 individuals will be recruited, in line with the project scope, to participate in a day of discussion and ranking, to determine the top 10 questions for research. All participants will declare their interests. The Steering Group will advise on any adaptations needed to ensure that the process is inclusive and accessible.
Dissemination of results
The Steering Group will identify audiences with which it wants to engage when disseminating the results of the priority setting process, such as researchers, funders and the maternity communities. They will need to determine how best to communicate the results and who will take responsibility for this. Previous PSPs’ outputs have included academic papers, lay reports, infographics, conference presentations and videos for social media.
It should be noted that the priorities will not be worded as research questions. The Steering Group will discuss how they will work with researchers and funders to establish how to address the priorities and to work out what the research questions are that will address the issues that people have prioritised.
The JLA encourages PSPs to report back about any activities that have come about because of the PSP, including funded research. The RCM will evaluate the impact of the PSP and disseminate to the JLA and relevant stakeholders.
Agreement of the Steering Group
The midwifery practice and maternity care PSP Steering Group agreed the content and direction of this Protocol on 4 December 2023.