Table 8 An example of a staged approach to evaluation

One of the Better Start Bradford interventions is a personalised midwifery model adapted from the evidence based continuity of care model [1]. The adaptation was the removal of continuity at delivery due to local concerns of high burden on midwives. The removal of a key component means there is no evidence of implementation or effect for this intervention. The first stage of evaluation that we undertook was an implementation evaluation to look at the feasibility, fidelity and acceptability of the model using midwifery data, complemented with structured interviews with midwives and women who had recent midwifery care. The implementation results helped us to demonstrate that the intervention was feasible and acceptable and also helped to identify the key components and outcomes that can be rolled out to other midwifery teams in the area. The next step will be an effectiveness evaluation using routinely collected data to explore the benefits of continuity of care without the birth element. This evaluation will use propensity score matching within the BiBBS cohort.

To assess whether an intervention is ready for an effectiveness evaluation we use an evaluability checklist [2]. This considers numerous important factors including: availability of good quality data, use of validated outcome measures, continuous good recruitment and engagement, intervention delivered with fidelity and indication of promise from previous evaluations.

1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: https://doi.org/10.1002/14651858.

2. Davies, R. Planning Evaluability Assessments: A Synthesis of the Literature with Recommendations. 2013. Report of a Study Commissioned by the Department for International Development.