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Developing Rapid Realist Methods for Evaluating Accountability Frameworks in Maternity Services(code R1.1_Birmingham)

Capacity Development

The Opportunity

  • International students are welcome to apply but must secure alternative funding for the difference between UK and Overseas tuition fees.

The Project

Accountability frameworks are increasingly used within healthcare to improve quality, safety, equity and organisational performance. These include governance arrangements, quality assurance processes, regulatory mechanisms, learning systems, equity action plans and performance monitoring frameworks. Despite widespread implementation, evidence regarding how accountability frameworks work, for whom, in what circumstances and through which mechanisms remains limited.

Maternity services provide a compelling empirical lens through which to develop and refine rapid realist evaluation methods. The sector is characterised by the rapid rollout of policies, governance reforms and accountability initiatives in response to national safety reviews and persistent racial disparities in maternal outcomes. These dynamic and complex organisational environments require evaluation approaches that can generate timely explanations of how accountability mechanisms function, rather than simply whether they achieve intended outcomes.

Patient and Carer Race Equality Framework (PCREF) is an NHS anti-racism accountability framework for mental health services. It is the first mandatory anti-racism framework which is expanding into maternal and perinatal care pathways from 2025/26. The PCREF focuses on 3 areas:

Leadership and governance – trust boards will lead on creating and monitoring plans to reduce health inequalities.

Data – trusts must publish new data on progress in reducing health inequalities, and include ethnicity information in all existing core data sets.

Feedback – trusts must put clear, visible ways in place for patients and carers to give feedback, and show how that feedback leads to action.

This research aims to develop, and test a method for conducting rapid realist evaluations of accountability frameworks in maternity healthcare systems. This is important as realist evaluation offers an approach to understanding complexities by identifying Context-Mechanism-Outcome (CMO) configurations. However, full realist evaluations are resource intensive and may take several years to complete, limiting their usefulness for policymakers and healthcare organisations requiring timely evidence to assess the efficacy of newly rolled out programmes.

Co-produced with stakeholder and community engagement, this project will; 1) identify and assess the efficacy of existing realist methodologies and rapid methodologies which adopt realist approaches, 2) collate the facilitators, barriers and recommendations to delivering rapid realist methods, 3) through qualitative assessment, develop methodological outputs including guidance, implementation tools and recommendations, and 4) test the explanatory power and equity alignment of the methodological output with assessment of the PCREF in perinatal mental health services.

Developing rapid realist methods in this context will produce methodological advances with relevance across healthcare while addressing a pressing need for evidence to support equitable and accountable maternity care. This will help identify early indicators of successful implementation and has the potential to improve women’s lives by strengthening the evidence base for accountability in maternity services.

Contact Supervisor – Michelle Fisher, m.l.fisher@bham.ac.uk

 

Who is a MDC PhD studentship for? 

We welcome applications from individuals passionate about maternal health equity with particular methodology knowledge and experience. We are committed to building a supportive, inclusive, and caring research community. We particularly encourage applications from: 

Eligibility Criteria

Essential

  • A Master’s degree in a relevant field (epidemiology, global health, medical science, public health, applied health, social science, psychology) or significant relevant clinical experience (midwifery, MBChB etc.).
  • Understanding of and commitment to tackling maternity inequalities. 
  • Relevant previous research experience – this experience may be relevant to either the research or methodological area. 
  • Excellent written and verbal communication skills. 
  • Highly motivated. 
  • Able to work both independently and as part of a team. 
  • Able to plan and manage own work. 
  • International applicants are welcome to apply for studentships, but applicants who are selected for interview must be able to provide proof of funding for international fees and immigration costs prior to their interview.   
  • Where English is not your first language, you must show evidence of English language ability to the following minimum level of proficiency: an overall IELTS score of 7.0 or above, with at least 6.5 in each component or an accepted equivalent. Please note that your test score must be current, i.e. within the last two years. The only exception to the above would be if applicants can provide a Master’s certificate completed in a UK institution with an outcome of merit or distinction, taken within the last two years.

Desirable

  • Experience of conducting qualitative or mixed-methods research.
  • Demonstrable interest in health inequities, maternity care, realist methods, implementation science, healthcare evaluation or organisational change.
  • Strong stakeholder engagement skills.

*All students will be expected to be based at their host university and meet the individual university PhD studentship regulations. Please check individual university postgraduate admissions.

Accessibility and Support

NIHR Inequalities Challenge: Maternity Disparities Consortium

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