A Qualitative Study on Midwife-Led Outpatient Care Quality from Multiple Perspectives Based on the Structure–Process–Outcome Model

Aim: To identify indicators of midwife-led outpatient care quality within the Structure– Process–Outcome (SPO) model by integrating perspectives from pregnant and postpartum women, midwives, nursing managers and obstetricians, informing an SPO-based evaluation framework. Design: Qualitative study using directed content analysis. Methods: From May to August 2025, multi-stage purposive sampling was employed at a tertiary hospital. Semi-structured interviews were conducted until data saturation was reached with thirty-three participants: eight pregnant women, six postpartum women, five combined clinic women, seven midwives, four nursing managers and three obstetricians. Audio-recorded transcripts and field notes were analysed; codes and themes were mapped to SPO domains. Results: Analysis identified eleven themes and eighteen subthemes organised within the three SPO domains. Structure-related themes involved information access and promotion, clinic configuration and operation (staffing, midwives’ qualifications and service hours) and facilities and institutional standards. Process-related themes included antenatal services (health education and birth-preparation interventions such as perineal massage), postnatal services (wound care, breastfeeding support and additional counselling) and continuity of care with the same midwife. Outcome-related themes focused on maternal satisfaction, contributions to obstetric practice and maternal–infant outcomes, alongside challenges in quality management (insufficient standardisation of quality indicators, staffing and scheduling constraints and limited prescribing authority) and proposed improvements such as service expansion and incentive mechanisms. Conclusion: This Structure–Process–Outcome (SPO) based qualitative study integrates diverse perspectives from service users and healthcare providers to identify key factors for quality improvement. The findings reveal that for midwife-led clinics to achieve sustained improvements in continuity and maternal–infant outcomes, health systems must critically strengthen three areas: structural positioning, resource allocation, and the standardization of evidence-informed care processes. Therefore, a necessary next step is the development of robust, SPO-aligned quality indicators, which are directly derived from the study’s identified themes. These indicators are essential for the effective monitoring and continuous improvement of outpatient services. Keywords: midwife-led clinics, outpatient care, qualitative research, structure–process–outcome model, quality indicators