title: Evaluating midwifery-led antenatal care: using a programme logic model to identify relevant outcomes.
abstract: BACKGROUND
  a range of initiatives has been introduced in Ireland and internationally in recent years to establish midwifery-led models of care, generally aimed at increasing the choices available for women for maternity care. A midwifery-led antenatal clinic was first established at the study site (a large urban maternity hospital in Dublin) and extended over recent years. This paper reports on the design of an evaluation of these midwives clinics, in particular the use of a programme logic model to select outcomes to be included in the evaluation.
  
  
  OBJECTIVE
  the programme logic model is used to identify the theory of a programme and is an integrative framework for the design and analysis of evaluations using qualitative and quantitative methods. Through an inclusive approach, the aim was to identify the most relevant outcomes to be included in the evaluation, by identifying and linking programme (midwifery-led antenatal clinic) outcomes to the goals, inputs and processes involved in the production of these outcomes.
  
  
  METHODS
  the process involved a literature review, a review of policy documents and previous reviews of the clinics, interviews with midwives, obstetricians and managers to identify possible outcomes, a focus group with midwives, obstetricians, managers and women who had attended the clinics to refine and prioritise outcomes, and a follow-up survey to refine and prioritise the outcomes identified and to identify sources of data on each outcome.
  
  
  RESULTS
  seven categories of outcomes were identified: (1) choice, (2) relationship/interaction with caregiver, (3) experience of care, (4) preparation and education for childbirth and parenthood, (5) effectiveness of care, (6) organisational outcomes, and (7) programme viability. A range of sources of information was identified for each outcome, including existing documentation and data, chart audit, survey of women, and interviews and focus groups with midwives, obstetricians, managers and women.
  
  
  CONCLUSIONS
  the programme logic model provided an inclusive, systematic and transparent approach to identifying relevant outcomes to be included in the evaluation. The information obtained has been used since to design the evaluation project, which is currently being concluded.
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland. Electronic address: michelle.butler@ucd.ie.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Butler
authors.forename: Mary C
authors.initials: MC
authors.lastname: Brosnan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Drennan
authors.forename: Patricia
authors.initials: P
authors.lastname: Feeney
authors.forename: Orla
authors.initials: O
authors.lastname: Gavigan
authors.forename: Maureen
authors.initials: M
authors.lastname: Kington
authors.forename: Denise
authors.initials: D
authors.lastname: O'Brien
authors.forename: Lucille
authors.initials: L
authors.lastname: Sheehy
authors.forename: Maura C
authors.initials: MC
authors.lastname: Walsh
mesh_terms: D005260:Female; D006801:Humans; D007494:Ireland; D016015:Logistic Models; D008880:Midwifery; D018743:Perinatal Care; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods*
keywords: Antenatal care; Evaluation; Midwifery-led care; Programme logic model