95 Women’s satisfaction of aCTG in primary midwife-led care The overall client satisfaction based on the CQ-I was very high. The mean satisfaction level varied from 3.98 (SD± 0.11) for the subscale “client satisfaction” to 3.87 (SD± 0.32) for the subscale “information provision”. This study showed a mean general satisfaction score of 9.19 on a scale from 1 to 10. In total, 77.4% of the respondents rated general satisfaction as a nine or higher. Women between 33 and 36 weeks gestation were more likely to be highly satisfied. Compared to a completely comfortable position during the aCTG, women in a mostly comfortable or somewhat comfortable position had decreased odds of being highly satisfied. Interpretation Pregnant women reported a high level of satisfaction with aCTGs in primary midwifeled care.. A study by Hildingsson et al. showed that overall satisfaction with antenatal care was high in Sweden and Australia (90-92%).18 Furthermore, they observed that the most important factors contributing to low satisfaction with antenatal care were deficiencies in information about pregnancy-related issues and in being taken seriously by the midwife. We found high satisfaction levels on the CQ-I in our study for the subscale “information provision” (3.87) and for the question “being taken seriously” (3.99) on a 4-point scale, showing this care meets these expectations. The maternity care CQ-I was also used in a study by Wiegers et al. on the quality of maternity care in the Netherlands as experienced by women.19 For midwife-led care, this study showed an average quality of treatment score of 3.79, which is slightly lower than our finding of 3.98 for this subscale. For general satisfaction, they found a score of 9.16, which is in line with the 9.19 in our results. In terms of healthcare technology, Goberna et al. found that women are often satisfied with new developments in this field.20 They also found three main aspects that are perceived as essential to high-quality care: safety (the hospital and its technological facilities and the technical expertise of health professionals), the structural aspects that determine the context in which healthcare is provided, and the relationship between the carers and the service user. This may explain the high satisfaction rate in our study, as we found that the question about women’s confidence in their healthcare provider’s expertise scored 3.95. Furthermore, the literature shows that continuity of caregiver is positively associated with women’s experiences of maternity care.7,19,21,22 For this reason, our findings regarding satisfaction level may partly be related to the fact the aCTG was performed by the woman’s own midwife in 87.7% of the cases. Lastly, for most women, the travel distance to the aCTG location was shorter than the nearest hospital (57.7%), which may have improved the accessibility of care. 4
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