Abstract
BackgroundMeaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions.MethodsFourteen maternity care and health systems experts participated in a modified Delphi consensus process. The list of proposed indicators was derived from a previously published scoping review. Fourteen participants rated each proposed indicator according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration.ResultsConsensus was achieved after two rounds, as measured by a Cronbach’s alpha of 0.87. Eleven indicators, many of which represented physical health outcomes, were ranked highly on all four criteria. Twenty-nine additional indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Travel for care, cultural safety and upstream structural determinants of health were identified as important themes.ConclusionsThis study identified the important gaps between current performance measurement strategies and the context and values that permeate maternal-child health in circumpolar regions. The indicators identified in this study provide an important foundation for ongoing work. We recommend that future work encompass an appreciation for the intersectoral nature of social, structural, and colonial determinants of maternal-child health in circumpolar regions.
Highlights
Meaningful performance measurement requires indicators to be scientifically robust and strategically focused
Selected indicators This study demonstrates the ability of a modified Delphi approach to achieve consensus among a geographically dispersed and professionally diverse group of stakeholders from circumpolar regions
We identified many indicators that more broadly reflect the priorities in circumpolar regions and warrant further consideration and development
Summary
Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. Indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions. Among health systems around the world, performance measurement has become an increasingly popular tool in the pursuit of health care quality, accountability, and value for money [1,2,3,4] This trend has been accompanied by an explosion in the number of available performance. “circumpolar” refers to all of Alaska, Greenland, Iceland, the Faroe Islands, and the northernmost territories of Sweden, Finland, Norway, Russia and Canada These regions are diverse in their geography, populations and health systems, and some areas experience more health inequities than others. It is imperative to consider the historical and ongoing impacts of settler colonialism and the substantial health inequities that exist both within and between circumpolar regions and disproportionately affect Indigenous peoples and communities
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