Exploring communication in antenatal care for Black pregnant women
| ISRCTN | ISRCTN17016197 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN17016197 |
| IRAS number | 329792 |
| Secondary identifying numbers | Arts and Humanities Research Council (AHRC) Grant Codes: AH/R012415/1, CPMS 61928, IRAS 329792 |
- Submission date
- 25/06/2024
- Registration date
- 27/06/2024
- Last edited
- 28/07/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Pregnancy and Childbirth
Plain English summary of protocol
Background and study aims
Research has shown there to be racial disparity in maternal health outcomes and experiences of maternity care. When asked about their experiences of maternity care, Black women frequently talk about good communication as connected to positive experiences and failures of communication as connected to poor experiences. This research aims to explore the relationship between communication, experience, and outcome for Black women receiving midwifery antenatal care. It is hoped that the findings of this study can be used to develop midwifery training materials and to make policy recommendations targeting improvement in outcomes and experiences for Black pregnant people.
Who can participate?
White midwives are eligible to participate if they deliver antenatal care at a participating site. Black pregnant women or birthing people can participate by invitation only if they are receiving antenatal care at a participating site with a participating midwife.
What does the study involve?
The study aims to video or audio record 20-30 antenatal appointments between Black pregnant women and their white midwives. These recordings will then be transcribed for conversation analysis. This method looks at how and when things are said and how actions are completed, by studying small details of the interaction such as choice of words, pauses, tone, and body movements. Pregnant women participants will also be asked to complete a short exit questionnaire after their appointment and to take part in a follow-up interview with the research team. The questionnaire and interview will ask about the participants' experience of communication in the appointment.
What are the possible benefits and risks of participating?
There are no personal benefits for participants taking part in the study. However, participation will contribute to the creation of knowledge which aims to improve the training of midwives and the experiences and outcomes of expectant Black mothers.
Risks to participating are low and where they exist, efforts have been made to minimise these.
Every effort will be made to ensure the anonymity of research participants. Transcribed data will be fully anonymised. Clips of video or audio recordings used for dissemination or training purposes will have names and other identifying information removed and replaced with pseudonyms or blanks. Voices will be distorted to make them unrecognisable. Video footage will be made to look like a sketch drawing and the faces of participants will be blurred.
Should participants feel uncomfortable or anxious about participation during the appointment, or follow-up interview, they can ask for the recording to be stopped, and anything recorded to that point will be deleted.
Disruption to the appointment will be minimised by the use of small, unobtrusive recorders, operated by the midwife. The research team will not be in the room.
Where is the study run from?
The University of Ulster
When is the study starting and how long is it expected to run for?
December 2021 to June 2025
Who is funding the study?
The study is being undertaken as a PhD funded by the Arts and Humanities Research Council via the Northern Bridge Consortium Doctoral Training Programme, with match funding from the Department of Economy, Northern Ireland
Who is the main contact?
Catherine Turner (PhD researcher), turner-c19@ulster.ac.uk
Contact information
Public, Scientific
Ulster University, Room BC-04-226, 2-24 York Street
Belfast
BT15 1AP
United Kingdom
 ORCID ID |
0000-0003-1498-4429 |
|---|---|
| Phone | +44 (0)7754 107379 |
| turner-c19@ulster.ac.uk |
Principal Investigator
Ulster University 2-24 York Street
Belfast
BT15 1AP
United Kingdom
| ORCID ID |
0000-0002-8111-2543 |
|---|---|
| Phone | +44 (0)28 9536 5904 |
| cs.rhys@ulster.ac.uk |
Study information
| Study design | Observational qualitative study |
|---|---|
| Primary study design | Observational |
| Secondary study design | Qualitative content analysis |
| Study setting(s) | Hospital, Internet/virtual, Telephone, Other |
| Study type | Quality of life |
| Participant information sheet | Not available in web format, please use the contact details to request a patient information sheet |
| Scientific title | Exploring the relationship between communication, experience and outcome for Black pregnant women receiving midwifery antenatal care: a conversation analytic study. |
| Study objectives | The study is a conversation analytic project. This is a data-driven, qualitative and observational methodology, and as such does not have a study hypothesis. The objectives of the study are as follows: Primary research objective To use conversation analysis to inductively explore the relationship between communication, experience and outcome for Black women receiving midwifery antenatal care. Secondary research objectives 1. To conduct micro-analyses of interactional practices observed in antenatal appointments, for example, practices related to information exchange, decision-making, listening and membership categorisation. 2. To contextualise observational findings within self-report data designed to capture pregnant women’s subjective experience of antenatal appointments. 3. To provide bottom-up, interactional data for use in midwifery training materials. 4. To make policy recommendations regarding communication practice in UK maternity services and the care of minority ethnic women in UK maternity services. |
| Ethics approval(s) |
Approved 12/06/2024, HSC REC A (Office for Research Ethics Committees Northern Ireland (ORECNI), Business Services Organisation, Unit 4, Lissue Industrial Estate West, Rathdown Walk, Moira Road, Lisburn, BT28 2RF, United Kingdom; +44 (0)28 95 361400; RECA@hscni.net), ref: 24/NI/0051 |
| Health condition(s) or problem(s) studied | The relationship between communication, experience and outcome for Black women receiving midwifery antenatal care |
| Intervention | The research design will combine a detailed analysis of the language used in antenatal appointments between Black pregnant women and white midwives, with a complementary analysis of the pregnant women participants’ subjective experiences of this communication and their satisfaction with any decisions made during the appointment. Data collection 1 – Observational data The research team aim to video or audio record 20-30 antenatal appointments between Black pregnant women and white midwives collecting observational data for conversation analysis. Audio-visual recording is preferable to capture non-verbal communication, which is known to be a commonly used channel for affective behaviours or displaying emotion. However, pregnant women who do not wish to consent to audio-visual recording could consent to audio-only recording as an alternative. Midwives will not have the option to consent to audio-only recordings, as this would preclude any pregnant women participants in their care from selecting to be video-recorded Data collection 2 – Short questionnaire Immediately post appointment, pregnant women participants will be asked to complete a short (maximum 15-question) Likert scale questionnaire probing their experience of communication, wider experience, assessment of outcomes, and assessment of the salience of the race of either midwife or pregnant woman during the appointment. Completing this is expected to take between 2 and 8 minutes. Data collection 3 – Semi-structured qualitative interviews After a period of a minimum of 24 hours following the appointment, pregnant women participants who have consented will take part in a qualitative interview. This will allow for a period of reflection and may uncover different subjective truths to those captured in the contemporaneous data. The interviews will probe the same subject areas as the short questionnaire but be semi-structured to allow space for participants to explore their independent thoughts and observations in recognition that the interview itself can be an opportunity for reflexivity. Partial consent While it is preferred that participating pregnant women consent to all three data collection streams, it will be possible to consent to the recording of the antenatal appointment only. This will help minimise the burden on women while collecting sufficient data to build collections of linguistic phenomena for conversation analysis. It is considered that a complementary analysis of these phenomena can be conducted using data from only some of the participants. |
| Intervention type | Behavioural |
| Primary outcome measure | Specific interactional phenomena of analytic interest will be measured using conversation analysis of the data from interactional practices related to information exchange, decision-making, listening or membership categorisation at one timepoint |
| Secondary outcome measures | Women's subjective experience of communication in their antenatal appointment will be measured via a non-validated exit questionnaire and follow-up semi-structured qualitative interview at one timepoint |
| Overall study start date | 01/12/2021 |
| Completion date | 23/07/2025 |
Eligibility
| Participant type(s) | Patient, Health professional |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | Female |
| Target number of participants | Planned Sample Size: 40; UK Sample Size: 40 |
| Key inclusion criteria | This research has two distinct participant groups with two different inclusion criteria. Pregnant people participants 1. Black pregnant women or birthing people receiving antenatal care at a participating site with a participating midwife 2. Black identity will be determined by self-identification as any of the following racially characterised ethnicities on their NHS ethnicity data, as indicated on their consent form: Black or Black British - African, Black, or Black British - Caribbean, Black or Black British – Any other Black background, Mixed - White and Black Caribbean, Mixed – White and Black African 3. Attending a routine antenatal appointment from the booking appointment to the 40-week appointment Midwife participants 1. White midwives delivering antenatal care at a participating site 2. White identity will be determined by self-identification as White - British, White - Irish or White – any other White background, as indicated on their consent form |
| Key exclusion criteria | Pregnant people participants 1. Pregnant women or birthing people who do not meet all the inclusion criteria, e.g., pregnant people with other racially characterised ethnicities 2. Pregnant people who require a formal or informal interpreter during their appointment 3. Pregnant people with impaired capacity to consent, who require support to access antenatal care or make decisions about their care 4. Pregnant people under the age of 18 5. Pregnant people attending a non-routine or 41- or 42-week appointment Midwife participants Participants who do not meet the inclusion criteria |
| Date of first enrolment | 22/07/2024 |
| Date of final enrolment | 23/07/2025 |
Locations
Countries of recruitment
- United Kingdom
Study participating centre
London
N19 5NF
United Kingdom
Sponsor information
University/education
2-24 York Street
Belfast
BT15 1AP
Northern Ireland
United Kingdom
| Phone | +44 (0)2895365028 |
|---|---|
| e.bell2@ulster.ac.uk | |
| Website | https://www.ulster.ac.uk/ |
"ROR" |
https://ror.org/01yp9g959 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- AHRC
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/12/2025 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| Publication and dissemination plan | Findings will be written into a PhD thesis and submitted for publication in peer-reviewed journals, approximately one year following the overall trial end date. Other dissemination opportunities will be sought across academic, professional, and public channels which may include academic talks, policy briefings, development of training materials and user engagement in collaboration with public-facing organisations. |
| IPD sharing plan | The data sharing plans for the current study are unknown and will be made available at a later date |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol file | version 2 | 29/05/2024 | 26/06/2024 | No | No |
| Protocol file | version 3 | 17/07/2024 | 14/08/2024 | No | No |
Additional files
Editorial Notes
28/07/2025: Recruitment closed on 23/07/2025.
18/06/2025: The following changes were made to the trial record:
1. The recruitment end date was changed from 06/06/2025 to 23/07/2025.
2. The overall end date was changed from 20/06/2025 to 23/07/2025.
3. The plain English summary was updated to reflect these changes.
14/03/2025: The following changes were made to the trial record:
1. The recruitment end date was changed from 28/03/2025 to 06/06/2025.
2. The overall end date was changed from 11/04/2025 to 20/06/2025.
3. The plain English summary was updated to reflect these changes.
06/01/2025: The following changes were made to the study record:
1. The recruitment end date was changed from 14/01/2025 to 28/03/2025.
2. The overall study end date was changed from 31/12/2024 to 11/04/2025.
14/08/2024: Protocol uploaded.
23/07/2024: The following changes were made:
1. The recruitment start date was changed from 29/07/2024 to 29/07/2024.
2. The recruitment end date was changed from 10/12/2024 to 14/01/2025.
11/07/2024: The recruitment start date was changed from 15/07/2024 to 29/07/2024.
01/07/2024: The recruitment start date was changed from 01/07/2024 to 15/07/2024.
25/06/2024: Study's existence confirmed by National Institute for Health and Care Research (NIHR) (UK).
