Measuring Women’s Experiences with Maternity Services: Development of a Feedback Tool in Malawi

Background Feedback from maternity service users is critical to improving the quality of care, yet existing tools often lack contextual relevance and fail to capture experiential aspects of care. This study aimed to co-develop a maternity-specific feedback tool by engaging service users and relevant stakeholders in identifying meaningful quality indicators using participatory methods. Methods A qualitative, consensus-driven design was employed across two multi-stakeholder workshops held in July 2024 and February 2025 in Malawi. Participants included service users (individuals who received maternity care), service providers (health professionals), policymakers, and community representatives. Participatory techniques, specifically the World Café (a structured conversational process that supports open and intimate discussion), gallery walks (an activity where participants review and provide feedback on visual displays), and group discussions, were employed to elicit and prioritize quality indicators and assess delivery modalities for the tool. Data from transcripts, notes, visual materials, and observations were analyzed thematically, with triangulation of visual (pictures, charts) and verbal data enhancing the depth of insights. Two structured rounds of stakeholder feedback were used to refine the tool iteratively. Results A total of 95% (N = 46) of the invited stakeholders participated in the co-design workshop, and 95% (N = 39) attended the validation workshop. The resulting tool includes 27 antenatal, 28 labour and delivery, and 32 postnatal indicators across seven domains: respectful and dignified care, communication and education, emotional support, timely and equitable access, continuity and coordination of care, quality of services received, and overall satisfaction. The tool will be piloted in two formats, paper-based and electronic. These findings demonstrate that the tool comprehensively captures user experiences and is considered contextually relevant by stakeholders. Conclusion The participatory co-design process yielded a maternity feedback tool that aligns with user priorities and is tailored to Malawi’s health system. The feedback tool systematically captures women’s experiences using indicators valued by stakeholders, enabling scalable quality improvement in maternal care.