Table 3 Professionals’ views on the implementation of PRMs in Finnish maternity care

Sub-themes (n = the number of professionals mentioning the sub-theme)

Sample quotations

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

“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)

Information augmentation (11): getting additional valuable, and structured information from patients, and better understanding women and their needs

“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)

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

“So as a manager, …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)

Improvement of clinical practices (8): improving the service practices and quality of care, and increasing patient satisfaction

“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)

Sub-themes (n = the number of professionals mentioning the sub-theme)

Sample quotations

Data collection, processing and management (19): motivating women to routinely answer PRMs questions, developing advanced IT tools and systems, defining appropriate data access, and ensuring data security

“Women may feel exhausted to answer questions, especially after the baby is born… We need to motive women and kindly remind them to respond to (PRMs) questions across the care pathway.” (Interviewee No. 4, Educator and Researcher)

Development of measures and instruments (14): developing relevant, women-friendly and family-oriented measures, forming questions in an acceptable way, and avoiding complicated, long questions and lengthy questionnaires

“We also need to ask partners and care about partners’ feeling… Fear is the issue to be included in the questions. Currently, we are working a lot to reduce women’s fear of childbirth…There are too many questions defined in the standard. Questionnaire should not be long” (Interviewee No. 8, Midwife and Manager)

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.

“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)

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

“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)

Collaboration and coordination (6): establishing collaboration between different professionals and providers, optimizing information sharing

“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)

Sub-themes (n = the number of professionals mentioning the sub-theme)

Sample quotations

Current service culture and relevant efforts supporting PRMs implementation (13)

“Our postnatal ward midwives ask women about delivery experiences...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)

Busy mother (13)

“It is hard to do the survey in the delivery room. Women only stay 2 h 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)

Busy staff (9)

“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)

Current information infrastructure, systems and tools enabling data collection, processing and management (8)

“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.” (Interviewee No. 6, Midwife)

Lack of integration between different providers and regions (8)

“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)

Sub-themes (n = the number of professionals mentioning the sub-theme)

Sample quotations

Data bias caused by drop-out and being left out (14)

“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)

Improperly utilizing the data (4)

“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)

Causing burdens on staff (3)

“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)

Sub-themes (n = the number of professionals mentioning the sub-theme)

Sample quotations

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

“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)