Re-Assure: building on women’s experiences of maternity complications to develop an animation to help other women share their safety concerns about life threatening illness and enable maternity response.
During this project, a team from King’s Improvement Science worked with a writer and animator to develop a short co-produced film for women who have experienced serious complications in pregnancy or during the post-natal period.
While for the most part, pregnancy and birth are normal processes, emergencies can develop rapidly and unexpectedly. Previous research from King’s College London has shown that women’s knowledge of changes in their condition is an important resource to help early detection and diagnosis, but women can struggle at times to express and get their concerns taken seriously by staff (Rance S, McCourt C, Rayment J, et al., 2013; Mackintosh N, Watson K, Rance S, et al., 2015).
This project aimed to find an effective and creative way of valuing women's innate knowledge of their own bodies during their maternity experience. Through a cultural collaboration involving health service researchers, a writer and an animator the project set out to embolden women to speak up about any concerns they have about their or their babies’ health, and enable healthcare practitioners to listen and act on these concerns.
The team realised that the best place to elicit the material for this research to then develop into a script was from women post-hoc: women who had experienced maternity complications, and whose experience could benefit other women. Animation was identified as being an appropriate medium, as it could address serious issues in a warm and unthreatening way. Other decisions grew from these, including the need for the film to work without sound, so that it could be played in quiet settings, such as triage and waiting rooms, and for it to be translated into different languages. The short film was designed to be played on a loop, with isolated stills held between screenings like posters, which would provide links and further information.
With the help of partners and third sector organisations (Sands, Tommy’s, APEC, Mama Academy, ICP Support and Kings Improvement Science) the project team used social media to recruit women to the project. 34 women participated by attending workshops, or via telephone interviews or email to share what they thought should be included in the animation. A separate workshop was also held for staff to hear their perspectives.
The script for the animation is unique, in that it is derived wholly from what the women said in these workshops and interviews. The writer worked with the animator synthesising the data and developing the draft script and storyboard. The work-in-progress was presented at a follow-up workshop and shared with participants via email, and participants’ feedback was incorporated into the final draft.
Below are work-in-progress images from the project storyboard and animation:
The project had originally planned to include 'red flag' signs and symptoms of particular life threatening conditions in the film. However, as many women reported that they had experienced uncharacteristic symptoms while complications were developing the film focuses on enabling women to ‘know their normal’ and to trust their instinct. It also shows how family members and friends can help with picking up changes in women’s conditions and acting as advocates. The film provides tips for women to help them communicate their concerns to maternity staff to help women and staff develop a shared language around speaking up for safety.
There have been high levels of engagement in the project so far: having seen the draft, 82% of the women participants reported feeling that the film had to varying extent taken on board those maternity issues important to them. 97% of the women who helped develop the film have agreed to have their names credited on the animation.
All the women who participated in the project together with stakeholders (maternity leads and 3rd sector organisations) were invited to a screening of the film at King’s College London.
The film is available to watch below:
The researchers went on to work with Tommy’s charity to create a shorter version of the film which launched as part of AlwaysAsk campaign on 24 April 2017.
Since project end, Nicola has moved to a new position of Associate Professor in Social Science applied to Health at the University of Leicester. In recognition that the women who helped develop the Re-Assure film represented a particular demographic (well educated, White British), she has secured Wellcome Trust funds for the Diversity, ethnicity and voice follow-on project. Pregnant women (n= 21) from Indian, Bangladeshi and Pakistani communities and 11 community leads / members have been recruited via community and faith based networks to explore participants views of the film via focus groups and individual interviews. Project partners include the Attenborough Arts Centre and the Centre for BME Health. An artist, Lorna Dunn, produced visual minutes during the focus groups and has developed artwork from the narratives. The project team held an exhibition at the Attenborough Arts Centre in Leicester on March 9th 2018 to share the artwork and findings, and to discuss implications for the Re-Assure film dissemination and future research.
Findings from the Diversity, ethnicity and voice follow-on project can be seen here
Dr Nicola Mackintosh was the academic lead for the project. She was the lead researcher for the programme of research on escalation of care which underpins this project. Her PhD examined the construct of ‘rescue’ in hospital settings, and her post-doctoral fellowship based at King’s Improvement Science explored the implementation of technologies to improve patient and family contributions to safety. Nicola has taken up a new role as Associate Professor in Social Science Applied to Health at the University of Leicester where she will continue with her research on women’s involvement in maternity safety.
Professor Jane Sandall is Professor of Social Science and Women’s Health, a theme lead at CLAHRC South London, and capacity building lead at King’s Improvement Science. She is also a midwife and social scientist, and has led and collaborated on research on the quality and safety of maternity services using a range of methods. Jane was the programme lead for the research on escalation of care which underpins the Re-Assure project.
Dr James Harris is a clinical academic midwife. His doctoral training was hosted at UCL’s Centre for Behaviour change, and his post-doctoral research is based at King’s Improvement Science. He is the course director for an MSc in Improvement and Implementation science and works clinically as a senior midwife in a day-assessment/triage unit at a tertiary referral hospital.
Co-deviser of Re-Assure, Claire Collison brings her experience as a writer, artist, and facilitator to find creative solutions to all manner of challenges. She was Arts Editor for Disability Arts Magazine, and has recently taught Visual Literacy for The Photographers' Gallery, designed educational resources for Kettle's Yard, and created participatory city walks exploring the impact of breast cancer. Claire is currently Artist in Residence at The Women's Art Library, Goldsmith's College.
Patrick Beirne is an Animator/Designer and Director, whose work has clocked up over fifteen million, hits on YouTube alone, gaining awards and accolades, including: Cannes Lions Silver, D&AD yellow pencil. He was responsible for the design and animation of the film and is a founding member of Spy Pictures.
Re-Assure is a collaboration between King’s Improvement Science, King’s Women’s Health Academic Centre and artist Claire Collison, brokered and supported by the Culture Team at King’s College London.
This work is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust.