Validation of Newly Developed Quality Maternity Service Management (QMSM) Model for Primary Health Care Facilities

Purpose: Developing countries, including Nigeria, have the highest burden of maternal and neonatal deaths resulting from complications related to pregnancy and childbirth. The global report of deaths related to pregnancy and childbirth documented 600,000 maternal deaths annually. The unacceptable high rate of maternal and neonatal deaths in Nigeria has been persistently unabated. In Nigeria, the maternal mortality ratio in 2008 was recorded as 545/100,000 live births, and 576/100,000 live births in 2013. Women and children from low socioeconomic background are the vulnerable groups. The peculiarity of their vulnerability predisposes them to finding quicker and cheaper avenues to seek health care. The Primary Health Care (PHC) maternity facilities are to serve this large population of women and their babies at grassroots level. Therefore, the present quality of maternal care evident by the magnitude of severe maternal/neonatal morbidity and mortality in this region makes designing of a model that will serve as a framework for provision of quality maternity care to women and their newborns a worthwhile study. The essence of designing the QMSM model is to address the reported maternal and neonatal health issues in Nigeria. However, the validation of a new model to guide provision of maternity service at primary level is imperative before its implementation to the needy larger society. This constitutes the premise for this study.

Methods: This study utilized one of the stages of theory-generating research design - theory validation described by Chinn and Kramer (2015) to verify/validate the new Quality Maternity Service Management (QMSM) model. A total of seven (7) participants out of nine (9), who were involved and skilful in the operation of PHC services, including maternity, participated in the confirmation/validation process using a purposive sampling technique, and this provided 78% respondent rate. Voluntary purposive sampling was applied in selecting the PHC programme experts for the validation stage of the model development. The MOHs and the heads of facilities, who participated in the model validation, were selected because their administrative and decision-making roles in PHC organization. In addition, they occupy the apex of the organogram of PHC system. For the purpose of validation of the QMSM model, a semi-structured questionnaire was developed based on the model’s features and the components namely: the structure, the process, the outcomes, the system of funding and the system of monitoring/supervision. The questionnaire was administered to the PHC experts for responses. Detailed description and the sketched diagram of the model were sent to the experts for studying in order for them to acquire sufficient knowledge to make significant contributions to the model. Copies of the semi-structured questionnaires were administered by two research assistants. The data collected were analyzed with the aid of SPSS version 23. Both descriptive and inferential statistics were run; the results are presented in both texts and tables. All related ethical issues were addressed during the conduct of this study. Ethical clearance was obtained from relevant institutions. Prior to the commencement of data collection, informed consent was obtained from each participant, and all ethical considerations were adhered to during the study.

Results: The experts tested whether the model was adequate, accurate and represented reality for it to be assumed effective in achieving the set goal, if applied in midwifery practice. The composition of the experts who participated in the validation process of the model includes three (3) MOHs and four (4) CNOs. The experts rated the model on four criteria (its representation of reality, accuracy, appropriateness and applicability) using a 5-point Likert scale. On the Likert scale, the obtainable score was 20. The maximum obtained score was 16, while the minimum obtained score was 9; the mean score was 14.3 (≈ 14). Five (71.4%) experts rated the model above the mean score. Therefore, 71.4% of the experts accepted and confirmed the newly developed model as being valid. The 71.4 % confirmation/validation of the new model is unanimously considered as ‘good enough’ by the PHC experts, scholars and the researcher. All the experts unanimously adopted the label ‘Quality Maternity Service Management (QMSM)’ model for the newly developed model.

Conclusion: The study focused on validation of model development, and was done in line with a theory-generating research process in the literature supported by McKenna & Slevin, (2008) and Chinn & Kramer (2015). The developed model was tested and approved for its appropriateness, adequacy, accuracy and whether it represents reality, for it to be assumed effective in achieving the goal if applied in midwifery practice at primary level. Lastly, the implementation of the newly developed model is strongly recommended in other to improve women’s and newborn’s health.