Measuring health in maternity: an exploration of women-reported outcomes

This PhD thesis aimed to explore the impact of the maternity journey on low-risk nulliparous women to develop a long-form women-derived maternity-specific Patient Reported Outcome Measure (PROM): the Wellbeing Of Women in MATernity (WOWMAT). A mixed-method approach involving three phases included stakeholders and women in all stages. Phase 1 developed the conceptual framework that underpinned the new PROM and its items (questions), through literature reviews and qualitative interviews. The reviews showed the limited focus of existing PROMs, the limited exploration of woman’s perspective with regards to how their health and wellbeing is affected by the maternity journey, and the lack of a maternity-specific PROM applicable throughout their maternity journey. A new theoretical model of maternity was created to inform the preliminary conceptual framework. Qualitative interviews identified issues that affect how women feel, function and live their lives supporting the development of a new conceptual model of the wellbeing of women during their maternity journey that underpinned the final conceptual framework. Phase 2 involved best practice methods for item generation, selection, and refinement to craft a preliminary long-form WOWMAT questionnaire ready for pre-testing. Phase 3 used cognitive interviews (pre-testing) with low-risk nulliparous women to explore the relevance, clarity, and acceptability of the new PROM. This informed item reduction and modification of the PROM, and produced a long-form WOWMAT questionnaire, ready for future psychometric testing. This PhD has contributed a new understanding of the impact of the maternity journey and in doing so, developed a PROM grounded in women’s perspective.