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Exploring midwives' emotional wellbeing: evaluation of a survey using cognitive interviews

02 May 2023
Volume 31 · Issue 5



Surveys are a popular method of collecting data to explore factors associated with midwives' emotional wellbeing. However, existing survey instruments lack consideration of how working practices may influence outcomes. This study aimed to test the face and content validity of a new instrument by assessing midwives' comprehension of bespoke survey items.


A total of 24 cognitive interviews were conducted with midwives working across the UK. A framework matrix method facilitated descriptive and explanatory analysis of the interpretation of survey items. Interviews were followed by a discussion group with midwifery academics to help identify optimal wording of one problematic survey question.


A range of potential comprehension and response problems were identified, resulting in modifications and the addition of new survey items.


Cognitive interviews can be an effective method to confirm the relevance and usability of bespoke survey items and offer opportunities to improve wording to reduce potential sources of error, thus enhancing the face and content validity of surveys.

There is an increasing body of evidence from surveys to suggest that burnout is not uncommon in the midwifery workforce (Hildingsson et al, 2013; Henriksen and Lukasse, 2016; Fenwick et al, 2018a; Hunter et al, 2019; Stoll and Gallagher, 2019), with potentially better outcomes for midwives working in a caseload model (Newton et al, 2014; Dixon et al, 2017; Dawson et al, 2018; Fenwick et al, 2018b). However, there are conflicting findings on whether age, length of experience or weekly hours influence outcomes, which might be explained by differences in samples or methods of analysis.

The influence of working practices on job satisfaction are commonly captured through the analysis of open-ended survey responses. The ability for midwives to form relationships with women and have time to provide advice and high-quality care has been linked to job satisfaction, whereas working conditions, such as high or unreasonable workloads, working long shifts/hours with no breaks, staff shortages, or a lack of recognition or role support have contributed to job dissatisfaction (Sandall, 1998; Harvie et al, 2019; Cull et al, 2020). However, there is a gap in the evidence on how shift length and other working practices, such as the ability to take rest breaks, finish on time or intershift recovery, may influence outcomes, and no existing survey instrument incorporates these aspects.

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