Yvonne Kuipers, Alix Aitken-Arbuckle, Holly Jenkins, Kathryn Hardie, Amy Corrigan
5 min
Continuity of Midwifery Care (CMC) is a core component of Scottish maternity policy, yet its implementation has been hindered by a lack of a unified research strategy. While CMC is globally recognized for improving maternal and neonatal outcomes, Scottish efforts have previously lacked a proactive, evidence-based roadmap. This study aimed to bridge this gap by developing a systematic, stakeholder-informed research mission, vision, and agenda to guide future CMC research in Scotland.
Guided by implementation science, the researchers engaged 24 diverse stakeholders, including midwives, academics, policymakers, and service user advocates. The team employed a multi-stage process involving online polling, brainstorming sessions, and plenary discussions to gather insights. Data were synthesized through structural text reduction and interquartile ranking to identify key content elements. The team used the Tailored Implementation for Chronic Diseases (TICD) framework to categorize determinants affecting the functionality of the proposed mission and vision. Finally, stakeholders ranked 16 potential research topics to establish a prioritized agenda.
The study successfully formulated a clear mission and vision for CMC research, emphasizing the empowerment of midwives, the expansion of the evidence base, and the elevation of the 'being with women' philosophy. The analysis revealed that the 'capacity for organizational change'—specifically the priority of necessary change and capable leadership—is the most critical determinant for the success of this research strategy. Among the research agenda priorities, economic evaluation of CMC was ranked highest, followed by topics concerning the organization and management of care and the needs of future generations of users and providers.
By providing a structured, stakeholder-validated research agenda, this study offers a roadmap for researchers, funders, and policymakers to align their efforts. It shifts the focus from reactive, fragmented studies to a cohesive strategy that supports the long-term sustainability and evidence-based development of CMC, ultimately aiming to improve maternity care outcomes and professional practice in Scotland.
Abstract Background Continuity of midwifery care is a priority within Scottish maternity services, yet limited evidence on key determinants and the absence of a shared research strategy constrain progress; therefore, this study aims to develop a systematic, evidence-based, and tailored process to inform a comprehensive Scottish continuity-of-midwifery-care research strategy, including its mission, vision, and aligned research agenda. Methods Guided by implementation science, we engaged with 24 service providers, academics, managers, policymakers and service users’ advocates in Scotland. We collected data through an online poll, subgroup brainstorming sessions, plenary discussions, evaluations, video recordings, and research topic listings. Structural text reduction and a ranking and prioritisation process informed the synthesis and translation of the data into a research mission and vision. Interquartile ranking (Q 3 ) was employed to select relevant and suitable guiding content elements for the mission and vision. The domains and determinants affecting the mission’s and visions’s functionality and capacity were framed using the Tailored Implementation for Chronic Diseases worksheets. Mean scores indicated their level of impact on the mission and vision. The ranked research topics were scored and prioritised based on their importance and relevance. Results The research mission and vision were established. The capacity of change determinants, particularly the importance of necessary change and capable leadership, influence the capacity and operationalisation of the research mission and vision. Among the sixteen research topics, those focusing on economic evaluation, the organisation and management of continuity of care, and the future generation of continuity of midwifery care users and providers were ranked highest. Conclusions We created a continuity of midwifery care research strategy and developed insights into embedding and applying this approach within the Scottish research context, guiding the operationalisation and further development of research on the continuity of midwifery care.
Sam: That's almost a structural argument rather than an empirical one.
Alex: Exactly, and I think that's where the paper is most interesting to a methodologically-minded reader. They're not just reporting what stakeholders want studied — they're arguing that the feasibility of a research agenda is itself a function of organisational determinants. The TICD framework forces that question to be explicit.
Sam: What were the substantive research priorities that came out of the ranking?
Alex: Economic evaluation and the management of continuity of care were the highest-ranked substantive topics. The economic evaluation piece is particularly telling — health board managers are the ones holding implementation budgets, and without a credible cost-effectiveness case, CMC expansion stalls at the commissioning stage. That's not a new problem in implementation science, but it's useful to see it surface so clearly in the ranking rather than being assumed.
Sam: A careful referee would push on generalisability here. This is a Scottish context with a specific NHS structure.
Alex: That's the central limitation, and the authors are candid about it. The specific priority rankings are context-dependent — a different health system with different commissioning structures would likely produce a different ordering. What the paper is actually offering is the methodology for building a stakeholder-informed, implementation-grounded research agenda, not a universal list of questions. The TICD mapping process is portable; the outputs aren't meant to be.
Sam: So the contribution is more about the process than the product.
Alex: Which is a legitimate contribution, but it does mean you have to read the paper at the right level of abstraction. If you're a Scottish health board researcher, the specific priorities matter. If you're working in a different system, the value is in the funnel — brainstorming to structural reduction to interquartile ranking to framework mapping — as a replicable approach to agenda-setting under conditions of stakeholder heterogeneity.
Sam: Are there things the paper doesn't test that a follow-up should?
Alex: A few. The ranking tells you what stakeholders agreed was important, but it doesn't tell you whether acting on those priorities actually shifts implementation outcomes. That's the next empirical step — does a research agenda built this way produce studies that health boards actually use? There's also a question about whether the TICD framework itself is the right scaffold for maternity care specifically, given it was developed for chronic disease management. The authors use it pragmatically, but a more critical treatment of that choice would strengthen the theoretical grounding.
Sam: So it's a well-executed first step in a longer methodological programme.
Alex: That's a fair read. It establishes a replicable process, surfaces the organisational conditions that constrain implementation research, and produces a ranked agenda grounded in cross-stakeholder consensus. The limitations are real — small N, single context, no outcome validation — but they're appropriate to the stage of work. Thanks for listening to ResearchPod.