A Methodology for Evaluating a Midwife-Led Continuity of Care Model: Assessing Birth Experiences and Maternal Satisfaction Among Primigravidas in Urban Abidjan, 2020

Midwife-led continuity of care models are promoted to improve maternal outcomes, but robust evaluation methodologies tailored to low-resource urban settings in West Africa are lacking. A structured approach is needed to assess their impact on primigravidas, a group for whom the first birth experience can significantly influence future healthcare engagement. This methodology article details the design for evaluating a midwife-led continuity of care model’s effect on birth experiences and maternal satisfaction among first-time mothers in urban Abidjan, Côte d’Ivoire. The primary objective was to develop and test a culturally adapted, mixed-methods evaluation framework suitable for this context. The proposed methodology uses a concurrent mixed-methods design. Quantitatively, a validated maternal satisfaction questionnaire was administered postnatally to a cohort of primigravidas receiving midwife-led continuity care, with scores compared to a matched cohort receiving standard fragmented care. Qualitatively, semi-structured interviews were conducted with a purposive sample from the intervention group to explore experiential themes in depth. The design included rigorous ethical protocols for informed consent and confidentiality. As a methodology article, it presents no empirical study results. Pilot testing of the framework demonstrated feasibility, with high participant consent rates and feedback indicating that the translated tools were comprehensible and culturally appropriate. The described methodology provides a rigorous, context-sensitive framework for evaluating midwife-led continuity models in similar urban African settings. It balances quantitative measures with qualitative narrative understanding, addressing a specific gap in evaluation research for primigravid populations. Researchers should consider this mixed-methods framework for similar evaluations, with careful attention to local translation and piloting of instruments. Future studies could incorporate longer-term follow-up to assess sustained impacts on maternal health behaviours. midwifery, continuity of care, maternal satisfaction, birth experience, primigravida, methodology, mixed methods, Côte d’Ivoire This work provides a detailed methodological framework for researchers and clinicians seeking to evaluate midwife-led care models in comparable low-resource urban settings, with specific focus on the experiences of first-time mothers.