Kerstin Erlandsson

Introduction: Women's childbirth experiences provide information for improving the quality of maternity care. This study explored opportunities and challenges related to achieving a positive childbirth experience among women giving birth in health facilities in the WHO-defined South-East Asia...

Midwife-led continuous labor support is a woman-centered model of care that embodies a philosophy and deliberate approach to supporting women during labor [1]. It is founded on a collaborative rela...

Introduction: Chronic conditions are a significant global health challenge that adversely affects the quality of care for patients with type 2 diabetes (T2D). To evaluate and improve the quality of care, the Patient Assessment Chronic Illness Care (PACIC-5As) tool has been developed. It is the most widely used tool designed to assess the perceived quality of care among individuals with chronic conditions, including diabetes. Nevertheless, it has not yet been culturally adapted and validated in the Ethiopian context. Therefore, this study aimed to translate, culturally adapt, and evaluate the psychometric properties of the PACIC-5As tool in Ethiopia. Methods: A multicenter cross-sectional study was conducted among individuals with type 2 diabetes from March 24, 2025, to May 5, 2025, in the Amhara region’s comprehensive specialized referral hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through face-to-face interviews. The tool consists of 26 items and 5 domains. Content validity was assessed at both the individual and scale levels. Internal consistency was evaluated using Cronbach’s alpha (α) and composite reliability (CR), with a value ≥ 0.70 considered acceptable. Confirmatory factor analysis (CFA) was conducted to evaluate model fit and factor structure. Model fit was assessed using the absolute and incremental fit indices and interpreted based on the recommended thresholds. Convergent validity was computed using average variance extracted (AVE), with a value ≥ 0.4 considered adequate, while discriminant validity was evaluated using AVE and inter-construct correlations. Results: A total of 520 study participants were enrolled, and 517 (99.4%) were included in the study. The overall mean summary score of PACIC-5As-ET was 2.68 (±0.62). The content validity index at the item and scale levels ranged from 80% to 100%, with an inter-rater agreement of 95%. The Cronbach’s alpha and composite reliability (CR) of the PACIC-5As-ET were 0.93. The Cronbach’s alpha values for the subscales ranged from 0.71 (Assist) to 0.82 (Arrange). The test-retest reliability of PACIC-5As-ET was 0.94. The model fit indices were χ²/df (2.79), RMSEA (0.06), SRMR (0.08), GFI (0.89), and CFI (0.40). The AVE value of the overall PACIC-5As-ET was 0.93, and the subscales ranged from 0.47 (Advise) to 0.59 (Arrange). Conclusions: The Amharic version of the PACIC-5As-ET tool demonstrated excellent internal consistency and acceptable validity for assessing the perceptions of patients with T2D. The absolute fit indices were generally within the recommended range, whereas the incremental fit indices were low. Therefore, support for the hypothesized five-factor structure is limited and should be interpreted with caution.

Background: The quality of midwifery education and the quality of care are influenced by the capabilities of those who educate future midwives. In Bangladesh, where midwifery is a new profession, it is crucial that midwifery educators are supported, prepared and equipped to teach in both academic and clinical settings. This study aimed to identify the professional development needs of midwifery educators in Bangladesh. Methods: A cross-sectional online survey consisting of closed and open-ended questions, and statements answered using a four- and five-point response scale, was conducted. A total of 118 individuals responded to the survey, of whom 113 met the inclusion criteria and were included in the final analysis. Data were analysed using descriptive statistics including frequencies and percentages and inferential statistics (Spearman’s rank-order correlation and ANOVA). Internal consistency was evaluated using Cronbach’s alpha coefficient. Responses to the open-ended questions were analysed using systematic text condensation. Results: Among 113 respondents, working as an educator the majority (78%) held a master’s degree. The most reported development needs were in midwifery theory (41.6%), face-to-face teaching (41.6%) and clinical simulation (39.8%). Research capacity was also a key area, with 38.1% reporting a need for support in scientific manuscript writing. Leadership and management development were prioritised by 37.2%. Educators preferred face-to-face programme delivery (53.1%) and short, intensive formats (74%). Open-ended responses underscored a need for structured pedagogical training, as well as research and leadership mentorship. Conclusions: Continuous professional development for educators in Bangladesh is needed, particularly in education, research, and leadership. To address these needs, the study highlights the importance of incorporating its identified needs into a national educator development programme. We propose co-creating such a programme, guided by the ICM Global Standards for Midwife Faculty Development, to ensure a structured, relevant, and sustainable response.

Background: Women born in Somalia who have migrated to Sweden have increased risks of complications related to pregnancy and childbirth. Swedish-Somali women are, compared to women born in Sweden, less likely to contact healthcare for decreased fetal movements, which can be a sign of fetal distress. This study aimed to evaluate the effect of a Mindfetalness-based intervention in increasing awareness of fetal movements and its impact on birth outcomes among Swedish-Somali migrant women. Methods: An intervention study with a non-randomised control group, encompassing Swedish-Somali migrant women, with a singleton pregnancy, giving birth from gestational week 32 + 0 between June 2022 and June 2024. Data was collected from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. The intervention group consisted of 1,251 women who, in addition to routine information about fetal movements, also received information about Mindfetalness, a concept supporting women to become familiar with the baby’s movement pattern. The control group consisted of 1,555 women who only received routine information about fetal movement. Outcome measures included Apgar score at five minutes after birth, birth weight, neonatal intensive care unit admission, fetal death, onset of labour, mode of birth, and gestational age at birth. Log-binomial regression analyses were applied to assess associations between the intervention and selected outcomes. Results: There was a statistically significant increase in spontaneous vaginal births in the intervention group (RR 1.06, CI 1.01–1.11). No statistically significant differences between the intervention and control groups were observed for any other outcomes. Nearly one-third of women in both groups experienced a prolonged or post-term birth, while two-thirds were overweight or obese. The overall stillbirth rate ranged between 0.3% and 0.4%. Conclusions: The Mindfetalness intervention was associated with an increased incidence of spontaneous vaginal births, but no effect on other birth outcomes was observed. Implementing health interventions in a high-quality healthcare setting present challenges. When designing interventions to improve birth outcomes, it is essential to consider demographic data and the prevalence of risk factors within the target population. Further research involving stakeholders representing Swedish-Somali women is needed to understand the implications of this intervention. Trial registration: Retrospectively registered at ClinicalTrials.gov: NCT05540639, 30/06/2022.

Background: Midwifery models of care, endorsed by the World Health Organization (WHO), offer rights-based, person-centred care with proven benefits for safer maternal and newborn care worldwide. Despite these demonstrated benefits, the successful adoption of midwifery models of care depends on context-specific factors, making it essential to understand how healthcare leaders perceive and approach such transitions. Aim: To examine healthcare leaders’ perceptions of transitioning to midwifery models of care in Ethiopia and The Gambia, and to identify key barriers and facilitators influencing implementation. Setting: The study was conducted in Ethiopia and The Gambia within their respective maternal health system contexts, focusing on national and sub-national leadership perspectives. Methods: A qualitative study using open-ended, semi-structured interviews. An inductive thematic analysis was applied to explore leaders’ insights on midwifery models of care and system readiness for transition. Results: Facilitators included midwives’ active advocacy for women’s rights and strong community engagement in maternal health decision-making. Common barriers across both countries were workforce shortages, limited health system infrastructure, donor dependency, and persistent gaps in access for rural populations. Additional barriers included inadequate transport networks, geographic inaccessibility, financial challenges limiting women’s ability to reach skilled care, hierarchical governance structures that restrict midwives’ professional autonomy, insufficient facility readiness, and cultural resistance to evidence-based midwifery practices. Conclusion: Transitioning to midwifery-led models of care requires context-specific strategies aligned with the World Health Organization implementation guidance, with particular attention to strengthening infrastructure, financing, and workforce capacity. Contribution: The study underscores the need to integrate midwives more fully into policy and governance structures. Strengthening their leadership and advocacy roles may enhance the visibility, influence, and overall contribution of the midwifery profession within national health systems.