Discussion
’, Pain, pain
SAID
Aside from the White Ribbon Alliance’s survey in over 100 countries, including India, which tried to establish The PaGES Index combines qualitative and quantitative evaluations and can be used both before and after an intervention to evaluate experience and satisfaction within and between groups. It can also be used as a single-point three-step instrument, like the Mother-Generated Index [Subjective evaluations have been criticised because of a lack of standardisation and of reliability data [The number of mothers in this pilot phase of the MOLI study was too small to support inter-group statistical comparisons. The analyses and findings we have presented are therefore illustrative rather than formal. They are designed to show the instrument’s potential scope rather than to report the results of a particular study. However, while the mean bean count scores varied considerably (consistent with the theoretical expectation of a statistically over-dispersed Poisson distribution), with proper consideration of statistical power and sample size requirements and appropriate selection of statistical models, the bean count scores should be able to detect small but clinically important differences between groups. The PaGES Index, therefore, has the potential to provide a sufficiently sensitive instrument for use in clinical trials. Perhaps most obviously, this could be used to explore possible differences in experience between trial arms.Despite most PROMs / PREMs being developed through a lengthy process of consultation and trial [The PaGES Index allows for the participant-identified similarities and differences in the before and after evaluation to be reviewed. From a qualitative perspective, a simple description can be made of what was said before and after, with areas of overlap and difference examined. Given the fundamental nature of the intervention in this study (induction of labour and childbirth) it is not surprising that the overarching themes were very similar antenatally and postnatally, although the underlying comments varied to a greater or lesser extent. This allows for a comparison to be made between anticipated and actual experience on two levels: what participants say is important to them and how they rank these.Timing of administration is a critical feature. In this study women completed the PaGES Index at relatively short notice not long before the birth, and again within days of the birth. The degree of similarity in the postnatal responses may have been less had the mothers had more time to reflect on their experiences [In addition to the qualitative appraisal, the PaGES Index offers a quantitative comparison to compare the relative importance of the individual’s cited issues before and after. This is illustrated in Tables This is informative both when the issues raised by the participant are the same or similar (in this study, for example, antenatal anticipation of labour pain and postnatal description of the pain experience) or when ‘before’ concerns disappear but are replaced by ‘after’ concerns. In the latter case, for example, while only one of 38 women who had referred antenatally to lack of knowledge about childbirth also cited this postnatally, the concept of ‘Traas’ emerged postnatally. ‘Traas’ is a sentiment in Marathi ranging from mild inconvenience to vexation or even ‘torment’.While some of the themes identified at both time points were to be expected (‘Pain’, ‘Mode of birth’, ‘Gender of baby’), the PaGES Index allowed the women not only to raise issues like ‘treatment by staff’ and ‘traas’ but to rank their relative importance, giving the researchers an indication of their subjective ‘take’ on their current situation. They could also score their cited areas postnatally to produce an overall index score relating to experience and satisfaction. As has been found in several MGI studies in various countries including India [