‘It's about developing a trustful relationship’: A Realist Evaluation of midwives’ relational competencies and confidence in a Danish antenatal psychosocial assessment programme

Abstract

Objectiveto explore how contextual conditions influence midwives’ relational competencies, ability and confidence to undertake psychosocial assessment of pregnant women and their partners during the first antenatal consultation that identifies expectant parents in vulnerable positions. Designa realist evaluation carried out through three phases: 1) development 2) testing and 3) refinement of programme theories. Data was generated through realist interviews and observations. Settingnine community-based and hospital-based midwife clinics in the North Region of Denmark. Interventiona dialogue-based psychosocial assessment programme in the the North Region of Denmark was evaluated. Participants and data15 midwives were interviewed and 16 observations of midwives undertaking psychosocial assessment during the first antenatal consultation were conducted. Findingscontextual conditions at multiple levels which supported midwives’ relational competencies, autonomy and the power of peer reflection—and thus facilitation of a woman-centred approach and trust—were identified, i.e., being experienced, having interest, organisational prioritisation of peer reflection and flexibility. Where midwives lacked experience, competency development regarding psychosocial assessment, opportunities for peer reflection and autonomy to individualise care for expectant parents in vulnerable positions, the approach to assessment tended to become institution-centred which caused a distant dialogue and instrumental assessment which potentially harmed the midwife-woman/couple relationship. Conclusionmidwives’ ability and confidence to undertake psychosocial assessment were affected by whether individual and organisational contextual conditions empowered them to assess and care for expectant parents within a philosophy of woman-centred care. Accordingly, development of trustful midwife-woman/couple relationships — which is essential for disclosure — was achievable. These conditions become fundamental for securing quality of antenatal care for expectant parents in vulnerable positions.