How to Implement Digital Clinical Consultations in UK Maternity Care: the ARM@DA Realist Review

Area of Science:

• Maternal Health
• Digital Health
• Health Services Research

Background:

• The National Health Service (NHS) Maternity Transformation Programme emphasizes digital transformation.
• The COVID-19 pandemic accelerated the adoption of digital clinical consultations (telephone/video) in maternity care.
• Optimal integration of digital consultations into traditional pathways and potential equity concerns remain unclear.

Purpose of the Study:

• To explore the safe, appropriate, and acceptable implementation of digital clinical consultations within UK maternity services.
• To identify target populations, settings, and purposes for digital maternity care.
• To understand how digital tools can complement existing maternity care pathways.

Main Methods:

• A realist synthesis approach was employed, combining evidence from Organisation for Economic Co-operation and Development (OECD) countries (2010-present) with stakeholder insights.
• Data sources included published research, grey literature (policy documents, safety reports), and input from healthcare professionals, service users, and community organizations.
• The review involved iterative phases of theory development, evidence retrieval, and theory refinement using a realist logic (context, mechanism, outcome).

Main Results:

• The synthesis included 93 evidence sources and stakeholder insights, developing 15 programme theories and a conceptual framework.
• Digital clinical consultations were found to be acceptable and appropriate when personalization, informed choice for women, and staff support/autonomy were prioritized.
• The therapeutic relationship between women and healthcare professionals emerged as a key mechanism for ensuring safety and engagement in care.

Conclusions:

• Four 'CORE' principles for implementation were identified: Creating supportive environments, Optimizing consultations for responsiveness and personalization, Recognizing the importance of access and inclusion, and Enabling quality and safety through relationships.
• Future research should focus on equity and investigate digital consultations within specific maternity systems, services, and diverse groups of women.