What factors influence a Quality Improvement Collaborative in improving contraceptive services for foreign-born women? A qualitative study in Sweden.

backgroundImproved contraceptive services could reduce the unmet need for contraception and unintended pregnancies globally. This is especially true among foreign-born women in high-income countries, as the health outcomes related to unmet need of contraception disproportionally affect this group. A widely used quality improvement approach to improve health care services is Quality Improvement Collaborative (QIC). However, evidence on to what extent, how and why it is effective and what factors influence a QIC in different healthcare contexts is limited. The purpose of this study was to analyse what factors have influenced a successful QIC intervention that is aimed to improve contraceptive service in postpartum care, mainly targeting foreign-born women in Sweden.

methodsA qualitative, deductive design was used, guided by the Consolidated Framework for Implementation Research (CFIR). The study triangulated secondary data from four learning seminars as part of the QIC, with primary interview data with four QIC-facilitators. The QIC involved midwives at three maternal health clinics in Stockholm County, Sweden, 2018-2019.

resultsFactors from all five CFIR domains were identified, however, the majority of factors that influenced the QIC were found inside the QIC-setting, in three domains: intervention characteristics, inner setting and process. Outside factors and those related to individuals were less influential. A favourable learning climate, emphasizing co-creation and mutual learning, facilitated reflections among the participating midwives. The application of the QIC was facilitated by adaptability, trialability, and a motivated and skilled project team. Our study further suggests that the QIC was complex because it required a high level of engagement from the midwives and facilitators. Additionally, it was challenging due to unclear roles and objectives in the initial phases.

conclusionsThe application of the CFIR framework identified crucial factors influencing the success of a QIC in contraceptive services in a high-income setting. These factors highlight the importance of establishing a learning climate characterised by co-creation and mutual learning among the participating midwives as well as the facilitators. Furthermore, to invest in planning and formation of the project group during the QIC initiation; and to ensure adaptability and trialability of the improvement activities.