Identifying indicators of respect in maternity care in high resource coutries : a Delphi study

Mistreatment and disrespectful care of women in childbirth has been studied and documented internationally. Measurement tools that capture (dis)respectful behavior could support quality care guidelines and policies intended to serve respectful maternity care (RMC). Measurement tools relevant to high-resource contexts are lacking. This Delphi study aimed to identify indicators of RMC, including indicators capturing disrespect, from the point of view of a panel of international researchers, practitioners, and service users while attending to the appropriateness of the indicators for use among populations that experience stigma. These indicators are intended to create a registry of items for use in research on RMC in high-resource contexts. Two rounds of online instrument review and analysis were completed with a Delphi panel. Consensus was assessed according to agreement on the importance and relevance of the indicators in the first round, and agreement on the priority of the indicators for inclusion (by rank) in the second round. An initial set of indicators (n = 201) was drawn from the literature to populate the Round One online instrument. In Round Two, the panelists reviewed a revised list of 156 indicators grouped into 17 domains. In both rounds, consensus was supported using qualitative feedback gathered on individual indicators and groups of indicators. Findings showed that the panelists generally supported the indicators but demonstrated weak to moderate agreement with each other. In Round One, 191 out of 201 indicators exceeded a content validation index of 0.80. In Round Two, Kendall’s W ranged from 0.081 (p = 0.209) to 0.425 (p < 0.001) across the domains. After the two rounds, 14 indicators could be said to be strongly supported by the panel. These indicators represented the domains of verbal mistreatment, stigma and discrimination, physical exams and procedures, family and cultural support, autonomy (in decision making), and health system conditions and constraints (physical). Stability of panel agreement between rounds was difficult to assess. The strongly supported indicators identify care behaviours that are important for RMC and suggest areas of improvement for practice and education of healthcare providers.Applied Science, Faculty ofNursing, School ofGraduat