Phase 1 Summary

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By Georgia Clancy, ARM@DA Research Fellow.

Welcome to our first ARM@DA blog! This is the place where we’ll be providing updates, thoughts and reflections as the project goes on.

ARM@DA is a realist inquiry into maternity care at a distance. The aim is to understand when, where and for whom digital (remote) consultations are useful in maternity care services. Our project involves talking to women and healthcare professionals, as well as looking at existing research to get a better picture of how remote consultations should be used in future. We’re currently about half-way through ARM@DA, so we thought we would start our blog with an update on Phase 1.

The aim for Phase 1 was to develop a set of initial programme theories (IPTs) to explain how digital clinical consultations can work best. These IPTs would then guide later phases of the review.

We started by consulting the ARM@DA project advisory group, which consists of clinicians and researchers who can advise, shape and support the project. We also met with our stakeholder groups which are made up of healthcare professionals, services users and community organisations with maternity experience. These discussions helped us to focus and prioritise our work.

Next, we carried out a literature search to identify theory-rich evidence (including empirical papers, reviews, policy documents, guidance and theory). These texts were appraised and the relevant data extracted to generate context-mechanism-outcome (CMO) configurations. CMOs are a key part of realist inquiry, and are used to illustrate the context (the environment in which digital consultations happen), the mechanisms (the resources you need for digital consultations, including how people respond) and the outcomes (the potential effects of digital consultations). After we developed the IPTs we presented them to the stakeholders for feedback and refinement. For now, we’ve split our IPTs into those which relate to women (as service users) and those which relate to healthcare professionals and the organisations in which they work.

For women, our work so far suggests two main points. First, that women’s preferences for telephone or video consultations can vary a lot depending on their personal situation. So, it is important to take an individualised approach. Second, remote consultations may be difficult for some groups of women (e.g. women who don’t speak English well or who don’t have good internet access). So, it will be important for maternity services to think about how to make remote care accessible (to those who want it).

For staff, our work so far also suggests two main points. First, that it is important to have good systems, training and support at work so that remote consultations can be easily adopted. Second, staff feel it is important that they can make decisions about when to use remote consultations, so that they can be flexible and adapt care to meet women’s needs.

Our next step is to test and explore our IPTs in Phase 2. We’ll be sure to let you know how it goes!