85 Women’s satisfaction of aCTG in primary midwife-led care practices were approached by their midwives before the aCTG. Women filled out the questionnaire during or right after the consultation or in the privacy of their homes. The respondents were asked to return the questionnaire after the consultation or at the next appointment at the midwifery practice in a closed envelope to ensure confidentiality. If a woman had more than one aCTG, only her first experience was included, as two experiences within one person may be interrelated, which could cause bias. Measurement Tool A questionnaire was developed to assess the satisfaction of pregnant women with an aCTG in primary midwife-led care. The questionnaire included baseline characteristics of maternal age (<20, 20-36, >36), gestational age in completed weeks (28-32 weeks, 33-36 weeks, 37-40 weeks, >41 weeks), socioeconomic position (low, medium, high), the indication for the aCTG (reduced fetal movements, after external version, postdate pregnancy), the aCTG location (own midwifery practice, different midwifery practice, ultrasound or birth center, home), and travel distance (the same as, shorter or longer than traveling to the hospital). The socioeconomic position was based on the respondents’ postal code and categorized according to Statistics Netherlands (CBS).13,14 The satisfaction of pregnant women with an aCTG in primary midwife-led care was measured in two ways. (1) The questionnaire was based on the Consumer Quality Index (CQ-I).15 The CQ-I is a standardized and validated instrument for measuring, analyzing, and reporting client satisfaction with healthcare.15 The Cronbach’s α of the CQ-I is 0.8, showing good internal consistency. The CQ-I consisted of 14 evaluation questions with the following response options: 1) No, not at all, 2) Somewhat, 3) Mostly, and 4) Yes, completely. The CQ-I contained four different subscales: communication (four questions), information provision (four questions), client-oriented care (three questions), and treatment (three questions). (2) The general satisfaction level was measured using a 10-point Visual Analog Scale, with 0 meaning “not at all satisfied” and 10 meaning “completely satisfied”.16 The general satisfaction score was included in the questionnaire in two regions. Data collection started at different timepoints in each region (September 2016, November 2016, and December 2016). In the region where data collection started first, the question about general satisfaction was not included. To address the multidimensional nature of satisfaction, questions were asked about who carried out the aCTG (own midwife yes/no), the additional examination by ultrasound (yes/no), waiting time (none, <15 min, 15 – 30, >30), the time between the first contact with the care provider and the moment the aCTG took place (<30 min, 30 – 60, 60 – 90, > 90), level of comfort during the aCTG (not at all, somewhat, mostly, 4
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