Development of Quality Indicators for Pregnancy Care of People With Disabilities Using a RAND-Modified Delphi Method

This study aimed to develop quality indicators (QIs) for pregnancy care of people with disabilities.

We used a RAND-modified Delphi method. We first conducted a scoping review of Medline, Embase, PsycInfo, and CINAHL (2004-2024) to identify candidate QIs related to the structures, clinical processes, and interpersonal processes of pregnancy care for people with disabilities. Draft QIs were then validated in a 3-round Delphi study from June 2023 to October 2024, with an expert panel of 17 pregnancy care providers and 10 birthing people with disabilities. In round 1, panellists rated draft QIs on importance and feasibility in a survey. New QIs and QIs requiring rephrasing were identified. In round 2, QIs were discussed and refined in focus groups. In round 3, panellists rated new and revised QIs on importance and feasibility. The final list of QIs was created on the basis of panel consensus on importance.

The review identified 98 studies, from which 44 candidate QIs were created for structures (n = 12), clinical processes (n = 22), and interpersonal processes of care (n = 10). In round 1 of the Delphi survey, consensus on importance was achieved for all QIs, 5 of which were identified as requiring rephrasing. Panellists suggested 10 new QIs. In round 2, the new and revised QIs were discussed in focus groups. In round 3, the new and revised QIs achieved consensus on importance, resulting in a final list of 54 QIs (n = 43 achieving consensus on feasibility).

These QIs can assist health care providers, administrators, and policymakers in optimising the quality of pregnancy care for people with disabilities.