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Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol

Evans, Catrin; Evans, Kerry; Booth, Andrew; Timmons, Stephen; Jones, Nia; Nazmeen, Benash; Sunney, Candice; Clowes, Mark; Clancy, Georgia; Spiby, Helen


Professor of Evidence Based Healthcare

Andrew Booth

Professor of Health Services Management

Nia Jones

Benash Nazmeen

Candice Sunney

Mark Clowes


INTRODUCTION: One of the most commonly reported COVID-19-related changes to all maternity services has been an increase in the use of digital clinical consultations such as telephone or video calling; however, the ways in which they can be optimally used along maternity care pathways remain unclear. It is imperative that digital service innovations do not further exacerbate (and, ideally, should tackle) existing inequalities in service access and clinical outcomes. Using a realist approach, this project aims to synthesise the evidence around implementation of digital clinical consultations, seeking to illuminate how they can work to support safe, personalised and appropriate maternity care and to clarify when they might be most appropriately used, for whom, when, and in what contexts? METHODS AND ANALYSIS: The review will be conducted in four iterative phases, with embedded stakeholder involvement: (1) refining the review focus and generating initial programme theories, (2) exploring and developing the programme theories in light of evidence, (3) testing/refining the programme theories and (4) constructing actionable recommendations. The review will draw on four sources of evidence: (1) published literature (searching nine bibliographic databases), (2) unpublished (grey) literature, including research, audit, evaluation and policy documents (derived from Google Scholar, website searches and e-thesis databases), (3) expertise contributed by service user and health professional stakeholder groups (n=20-35) and (4) key informant interviews (n=12). Included papers will consist of any study design, in English and from 2010 onwards. The review will follow the Realist and Meta-narrative Evidence Synthesis Evolving Standards quality procedures and reporting guidance. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the University of Nottingham, Faculty of Medicine and Health Sciences Ethics Committee (FMHS 426-1221). Informed consent will be obtained for all key informant interviews. Findings will be disseminated in a range of formats relevant to different audiences. PROSPERO REGISTRATION NUMBER: CRD42021288702.


Evans, C., Evans, K., Booth, A., Timmons, S., Jones, N., Nazmeen, B., …Spiby, H. (2022). Realist inquiry into Maternity care @ a Distance (ARM@DA): realist review protocol. BMJ Open, 12(9), Article e062106.

Journal Article Type Article
Acceptance Date Aug 16, 2022
Online Publication Date Sep 20, 2022
Publication Date Sep 20, 2022
Deposit Date Aug 17, 2022
Publicly Available Date Sep 20, 2022
Journal BMJ open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 12
Issue 9
Article Number e062106
Keywords General Medicine
Public URL
Publisher URL


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