Primary themes
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Sub-themes (n=the number of professionals mentioning the sub-theme)
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Sample quotations
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Performance
whether an individual believes /expects that using the system will help to attain gains (expected usefulness)
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Maternity care system development (11): improving the whole maternity care chain, building an integrated care system and continuity of care, and enabling national and international comparison
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“The whole maternity care chain will get benefits from this, from primary care to specialized care, and it will help to build continuity of care” (Interviewee No.4, Educator and Researcher)
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Information augmentation (11): getting additional valuable, and structured information from patients, and better understanding women and their needs
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“I believe PROMs and PREMs will be helpful. I can get more information before the appointment, and the discussions with clients will be better. Now the thing is that if I don't ask them, women may not necessarily tell me the problems. (If women do not actively report), for some problems or risky issues, I may never know, or know them too later. If I know, I can help immediately. Now we don't have so much time always during the appointment, so it is good to know some issues beforehand. Then I can arrange the time more efficiently and avoid unnecessary questions during the appointment. If women report the problems before the appointment, I can give more information they need and spend more time in talking about the issues. And I can prepare better. I can ask right and important questions. I will know my clients better.” (Interviewee No. 17, PHN)
“We will know the patient’s feelings about the care, how they think about our system, and what care is wanted and needed.” (Interviewee No. 18, Gynecologist, Obstetrician and Manager)
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Improving management (10): getting a real picture of the overall situation, identifying the deficiencies in the service system, prioritizing the key issues to be addressed, and allocating resources better
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“So as a manager, I will know …what we should do more in order to improve the services and where we should pay more attention. I can see bottlenecks, rearrange resources, set the goals more realistically and logically, and guide the work to a right direction.” (Interviewee No.10, Gynecologist, Obstetrician and Manager)
“We can well identify the group that needs more help.” (Interviewee No. 19, Midwife and Manager)
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Improvement of clinical practices (8): improving the service practices and quality of care, and increasing patient satisfaction
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“Previously, the outcomes and quality are defined from the expert’s view, and the women’s and family’s views are missing. It is not only important to ask about (women’s feelings and perspectives), but also to add them and reply them so. It is a very valuable way to collect the information that you are not able to get from the current birth registers, and to follow the process and monitor the situation before something happens.” (Interviewee No. 1, Researcher)
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Effort
whether an individual believes /expects that there is any ease/complexity and cost associated with the use of the system
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Data collection, processing and management (19): motivating and training women, partners, and personnel, developing advanced data tools and systems, defining data access and ensuring data security
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“We should encourage the patient to report and let them know that they have the right and place to report problems and give feedback. That should be a part of the care, not just for improving the service system in general but helping the patient to solve problems and improving their own health. Patients have to be aware that they will be treated better after they report problems.” (Interviewee No. 4, Educator and Researcher)
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Development of measures and instruments (14): developing relevant, women-friendly and family-oriented measures, forming questions in way, and avoiding complicated, long questions and lengthy questionnaires
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“In Finland, we are concerned about domestic violence issue, and we may need to add questions about relationship with partner.” (Interviewee No. 12, Gynecologist, Obstetrician and Manager)
“It is also necessary to ask the partner too, because nowadays partners are involving more and more. Mother and partner could discuss and make decisions together, if there are any problems. This is Finnish culture that the partner involves a lot in the (pregnancy and childbirth) process. We should develop family-oriented questions” (Interviewee No. 17, PHN)
“Fear is the issue to be included in the questions. Currently, we are working a lot to reduce women's fear of childbirth” (Interviewee No. 8, Midwife and Manager)
“The questionnaires have to be made as easy as possible. Long and complicated questions will exhaust women. Women will refuse to give answers to lengthy and complicated questionnaires” (Interviewee No. 20, Midwife and Trainer).
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Data utilization and translation (9): properly utilizing the data and analysis results, responding to the emerging issues, providing necessary interventions, exploring the relation between PROMs, PREMs and other outcome measures.
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“If the score (answers to PRM questions) shows a bad situation, we need to think of how to give help and what is the next step. We need to know where to prefer the patient. If we don't prepare next step or tool (for the emerging issues), it is meaningless to collect the data.” (Interviewee No. 8, Midwife and Manager)
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Integration (7): integrating PROMs and PREMs into current information system and into routine service, making it as a part of care, integrating it with on-going surveys
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“A good way to integrate PROMs and PREMs into the daily service is to collect the PROMs and PREMs before each appointment. At the appointment, medical staff can discuss the emerging problems with patients, and give help or suggestions.” (Interviewee No. 1, Researcher)
“Making PROMs and PREMs data collection as a part of care, not as survey work, is the goal.” (Interviewee No. 11, Manager)
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Collaboration and coordination (6): establishing collaboration between different professionals and providers, optimizing information sharing
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“It is challenging for hospitals to collaborate with Neuvola and municipalities. Hospitals and Neuvola should know how to collaborate in information collection and sharing.” (Interviewee No. 3, Researcher)
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Condition
whether an individual believes /expects that there is any condition, e.g. organizational culture and technical infrastructure, existing to support/hinder the use of the system
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Current service culture and relevant efforts supporting PRMs implementation (13)
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“Our postnatal ward midwives ask women about delivery experiences, but not exactly with the same questions recommended by ICHOM. They (delivery hospitals) ask how it (the delivery) goes in general. It is mainly for the mother to speak out about their experiences. The scores are recorded. There have been some scale tools used to measure the mother's experiences, e.g. VAS (Visual Analogue Scale).” (Interviewee No. 6, Midwife)
“I believe our staff have positive attitude towards PROMs and PREMs approach. We want to make our clients satisfied with the service” (Interviewee No. 19, Midwife and Manager)
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Busy mother (13)
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“It is hard to do the survey in the delivery room. Women only stay two hours there after delivery, and there is so much to do already, checking the mother and the baby, going to shower, eating, and a lot of paperwork. After delivery, women are busy with the newborn and don't have enough time to answer too many questions.” (Interviewee No. 5, Educator)
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Busy staff (9)
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“We are already quite struggling with basic things and daily routines here at this moment. We do get lots of feedback on breastfeeding from mothers, complaining about insufficient information.” (Interviewee No. 7, Midwife)
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Current information infrastructure, systems and tools enabling data collection, processing and management (8)
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“We have started to adopt Apotti system (a regionally uniform social and healthcare information system, integrating all health and social care data, and allowing patients to check medical information, report health status and communicate with professionals). The primary healthcare of Vantaa has already implemented this system. Maybe it is a tool to collect PROMs and PREMs data. If Apotti comes to hospital, hospital can collect the information.” (Interviewee No. 6, Midwife)
“iPad is used in delivery unit to collect women's feedback. Women answer questions using iPad. If mothers have C-sections, they will be asked in postnatal ward using iPad. Midwives give iPad to women after delivery.” (Interviewee No. 5, Educator)
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Lack of integration between different providers and regions (8)
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“Delivery hospitals and Neuvola use different information system, so how to collect the information, which organizations collect which information, and how the information could be shared and used…all are challenging.” (Interviewee No. 1, Researcher)
“In Finland, different health regions use different information systems to collect and record patient information.” (Interviewee No. 12, Gynecologist, Obstetrician and Manager)
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Perceived risk
whether an individual perceives that using the system takes a possibility that something unpleasant or unwelcome (harm or damage) will happen to the current system and status
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Data bias caused by drop-out and being (14)
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“Questions should be asked at several times during the care pathway, but repeating answering the questions may cause lots of drop-out. That is the risk.” (Interviewee No. 1, Researcher)
“If the questionnaires are too long, patients will be tired of answering questions and will refuse to answer questions” (Interviewee No. 4, Educator and Researcher)
“Some groups of women, e.g. with low education or disadvantaged social status, may don't want to respond. Our problem now is that we don't get enough answers from immigrants and other disadvantaged groups. First (reason) is the language, and second is about culture. People from some cultural backgrounds are less likely to give feedback.” (Interviewee No. 11, Manager)
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Improperly utilizing the data (4)
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“If we don't plan next step or tool (to address emerged problems), it is meaningless and wasteful to collect the data.” (Interviewee No. 8, Midwife and Manager)
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Causing burdens on staff (3)
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“Our staff are too busy and burdensome to collect the data and we do lot of paper works now. We have to concentrate on key stuff.” (Interviewee No. 5, Educator)
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Social norms and influence
whether an individual believes that there is any social norm associated with the use of the system; whether an individual perceives that important others believe he or she should / should not use the system
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Healthcare principles and trends (16): patient-centered care, healthcare equality, integrated care and continuity of care, evidence-based medicine, and value-based healthcare, which are driving the application of PRMs
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“It is important to collect longitudinal PROMs and PREMs data for delivering patient-centered care. Now we have provider-organizing care, not truly patient-centered care.” (Interviewee No. 4, Researcher and Educator)
“We want to develop connected integrated care, where delivery hospitals and Neuvola collaborate and cooperate. For the patient, it is a whole service package.” (Interviewee No. 11, Manager)
“Evidence-based healthcare and patient-centered care will drive the use and implementation of PROMs and PREMs here in Finland” (Interviewee No. 20, Midwife and Trainer)
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