Co-development of a contextually relevant maternity service user feedback tool in Malawi using participatory consensus methods.
8 affiliations
- 1Maternal and Fetal Group, Liverpool Wellcome Programme, Blantyre, Malawi. [email protected].
- 2Maternal and Fetal Group, Liverpool Wellcome Programme, Blantyre, Malawi.
- 3Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
- 4Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi.
- 5Department of Midwifery, School of Maternal and Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
- 6Centre for Reproductive Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
- 7Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
- 8Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi.
Abstract
Background
Improving the quality of maternity care requires systematic incorporation of women's experiences into quality improvement processes. Although several instruments exist to measure maternity care experiences, few have been developed for routine feedback within low-resource health systems, and existing tools used in Malawi are generic and do not adequately capture maternity-specific experiences. This study aimed to co-develop and establish stakeholder-informed content validity for a context-specific maternity service user feedback tool for routine quality improvement in Malawi.Methods
We conducted a qualitative participatory consensus study involving two multi-stakeholder workshops held in Malawi between July 2024 and February 2025. Stakeholders included maternity service users, healthcare providers, policymakers, programme implementers, researchers, and community representatives. The tool was developed through a structured pathway comprising preparatory stakeholder engagement, co-design, prototype development, iterative refinement, and validation. World Café discussions, group discussions, gallery walks, structured voting, and thematic analysis were used to identify, prioritise, and refine feedback domains, indicators, and delivery modalities.Results
A total of 48 stakeholders participated in the co-design workshop and 39 participated in the validation workshop. Through iterative stakeholder consensus, approximately 300 recommendations were synthesised into 35 descriptive categories and subsequently refined into seven priority domains: respectful and dignified care; communication and health education; emotional support; timely and equitable access; continuity and coordination of care; quality of services received; and overall satisfaction. These domains informed the development of a maternity service user feedback tool comprising 27 antenatal care, 28 labour and delivery, and 32 postnatal care indicators organised into three modular questionnaires. Stakeholders recommended piloting both paper-based and electronic versions to support feasible implementation within routine maternity quality improvement systems.Conclusion
This study developed a stakeholder-informed maternity service user feedback tool tailored to the Malawian health system. The findings establish the tool's contextual relevance and stakeholder-informed content validity while providing a foundation for future evaluation of feasibility, reliability, construct validity, and implementation within routine maternity quality improvement programmes.
Related
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BibTeX
@article{gondwe2026codevelopment,
title = {{Co-development of a contextually relevant maternity service user feedback tool in Malawi using participatory consensus methods.}},
author = {Mtisunge Joshua Gondwe and Yamikani Chimwaza and Chifundo Kondoni and Leonard Mndala and Annie Kuyere Khumalo and Nyadani Chitsulo and Bertha Maseko and Catherine Bamuya and Luis Gadama and Lily Kumbani and Effie Chipeta and Elizabeth Chodzaza and David Lissauer and Alinane Linda Nyondo-Mipando},
journal = {BMC health services research},
year = {2026},
month = jul,
doi = {10.1186/s12913-026-15201-x},
url = {https://europepmc.org/article/MED/42908016},
note = {CC BY},
}
RIS
TY - JOUR
TI - Co-development of a contextually relevant maternity service user feedback tool in Malawi using participatory consensus methods.
AU - Mtisunge Joshua Gondwe
AU - Yamikani Chimwaza
AU - Chifundo Kondoni
AU - Leonard Mndala
AU - Annie Kuyere Khumalo
AU - Nyadani Chitsulo
AU - Bertha Maseko
AU - Catherine Bamuya
AU - Luis Gadama
AU - Lily Kumbani
AU - Effie Chipeta
AU - Elizabeth Chodzaza
AU - David Lissauer
AU - Alinane Linda Nyondo-Mipando
PY - 2026
DA - 2026/07/01
JO - BMC health services research
DO - 10.1186/s12913-026-15201-x
UR - https://europepmc.org/article/MED/42908016
AB - Background Improving the quality of maternity care requires systematic incorporation of women's experiences into quality improvement processes. Although several instruments exist to measure maternity care experiences, few have been developed for routine feedback within low-resource health systems, and existing tools used in Malawi are generic and do not adequately capture maternity-specific experiences. This study aimed to co-develop and establish stakeholder-informed content validity for a context-specific maternity service user feedback tool for routine quality improvement in Malawi.Methods We conducted a qualitative participatory consensus study involving two multi-stakeholder workshops held in Malawi between July 2024 and February 2025. Stakeholders included maternity service users, healthcare providers, policymakers, programme implementers, researchers, and community representatives. The tool was developed through a structured pathway comprising preparatory stakeholder engagement, co-design, prototype development, iterative refinement, and validation. World Café discussions, group discussions, gallery walks, structured voting, and thematic analysis were used to identify, prioritise, and refine feedback domains, indicators, and delivery modalities.Results A total of 48 stakeholders participated in the co-design workshop and 39 participated in the validation workshop. Through iterative stakeholder consensus, approximately 300 recommendations were synthesised into 35 descriptive categories and subsequently refined into seven priority domains: respectful and dignified care; communication and health education; emotional support; timely and equitable access; continuity and coordination of care; quality of services received; and overall satisfaction. These domains informed the development of a maternity service user feedback tool comprising 27 antenatal care, 28 labour and delivery, and 32 postnatal care indicators organised into three modular questionnaires. Stakeholders recommended piloting both paper-based and electronic versions to support feasible implementation within routine maternity quality improvement systems.Conclusion This study developed a stakeholder-informed maternity service user feedback tool tailored to the Malawian health system. The findings establish the tool's contextual relevance and stakeholder-informed content validity while providing a foundation for future evaluation of feasibility, reliability, construct validity, and implementation within routine maternity quality improvement programmes.
SN - 1472-6963
ER -