Abstract & Overview
Despite being well-positioned to identify service gaps and propose improvements, many midwives lack the knowledge, skills, confidence, or tools to effect practice change. Implementation science (IS) offers a structured approach to moving evidence-based innovations into practice; however, existing IS theories, models, and frameworks do not reflect the unique context of midwifery practice. The first step in the intentional implementation of an evidence-based practice innovation is to conduct a context assessment to identify factors that may facilitate or impede its uptake. There are numerous evidence-based checklists for this, but none capture all the influences on midwifery practice environments. In this study, a web-based, user-friendly tool to enable midwives to assess and capture change-readiness in their practice contexts - the 'Midwifery Tool for Change', or 'MT4C', was developed and evaluated. Employing a Participatory Action Research methodology, the MT4C was designed in collaboration with, and tested by, 25 midwives from a range of clinical settings in Australia and the United Kingdom. Data were collected through face-to-face focus groups, online surveys, and semi-structured interviews. Participants' insights at all stages shaped a contextually relevant tool embedded with key factors from established implementation science frameworks and adapted specifically for midwifery. The inability to consistently deliver the latest/best evidence-based care has been widely reported as a factor contributing to midwives' job dissatisfaction and to some leaving the profession. The MT4C supports midwives in initiating change while enhancing professional confidence, empowerment and autonomy. The MT4C is the first known implementation science tool developed exclusively for midwifery. The use of co-design ensured that it was grounded in the lived experiences of midwives and practical for real-world application. Supporting midwives to lead change from within can foster evidence-based, woman-centred care. In doing so, it may contribute to improved retention by enhancing job satisfaction and professional agency.