OBJECTIVE
To develop a set of contextually appropriate health system performance indicators for maternity care in circumpolar regions.
RESEARCH PROPOSAL
Specific attention will be placed on indicators that reflect the responsiveness of the health system to the needs of the population.
This study will be conducted in two phases. First, a scoping review (broad literature review) of available performance/quality indicators will be conducted. This review will seek to determine the extent, range and nature of published and in use performance or quality indicators which pertain to the delivery of maternity care in circumpolar regions and/or to Indigenous women. The second phase of the project will use a modified Delphi process (a formal process of achieving consensus among a group of individuals through the use of iterative surveys), to determine the best indicators of health system responsiveness as they pertain to maternity care in the circumpolar context.
Setting & participants: A multidisciplinary panel of maternity care and health policy experts in the circumpolar region will be assembled. This group will be composed of 10-15 individuals with balanced representation of measurement experts, and clinicians. In order to ensure adequate representation of different cultural groups, many of these individuals will be themselves Indigenous or will have dedicated a significant portion of their career to working in or with Northern Indigenous communities. Potential participants will be first approached to assess interest in participating and will then receive a formal invitation by e-mail with the first round electronic survey.
Research Procedure: From the results of the scoping review, a working list of candidate indicators will be compiled and first-round survey will be generated from this working list. Information about each indicator will be included where this information is available. Using a series of online surveys (FluidSurvey) with structured feedback, the panel will be asked to evaluate the importance and feasibility of each indicator on a 5-point Likert scale. Importantly, participants will also be invited to provide written comments and to suggest additional indicators that were not included on the candidate list.
Outcome & analysis: Summary statistics will be generated for each indicator and the degree of consensus will be measured. This information will then be distributed to the panel members along with a second iteration of the questionnaire. This process will be repeated in an iterative fashion until consensus has been achieved. This typically occurs after two rounds. Finally, a face-to-face meeting of the panel members will be organized in order to discuss the findings of the project, review the key indicators, resolve any outstanding disagreements, and establish future directions.
Background and Objectives: The goal of this project is to develop a set of health system performance indicators for maternity care in circumpolar regions. In general, the purpose of measuring and reporting health indicators is to evaluate the performance of one or more components of the health system. Indicators can evaluate a structure, a process or a health outcome and they allow the research team to understand how well the health system is functioning. Measurement and reporting of health indicators provide accountability and allows ministries and health care providers to make targeted improvements in care.
At present, the indicators that are in use for evaluating the maternity care system in Canada do not reflect the priorities of Northern communities. They do not capture the unique geographical and social challenges associated with delivering maternity care to women and rural and remote areas. This project will seek input from Northern experts in maternity care, Indigenous health and health policy in order to develop a set of indicators which appropriately capture Northern priorities. Local involvement will be at the level of a project advisory committee as well as at the level of participation in the consensus process used to build this set of indicators.
The proposed benefits of this project will be at both local and territorial levels. It is our hope that this project will help to build performance measurement capacity in the North and that the results of the project will help to direct improvements in the existing maternity care system so that women across the territory will have improved access to culturally appropriate, high-quality maternity care. At a local level, this project will provide Northern maternity care providers, policymakers and traditional knowledge holders with the opportunity to formally outline the priorities of their communities with respect to the delivery of maternity care.
Study findings will be published in the form of a thesis and will be shared in the peer review literature in open access journals. Survey results will be presented to study participants at the time of the consensus meeting.
The fieldwork for this study was conducted from October 1, 2015 to December 31, 2015.
