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Abstract

Background: The Continuity of Midwife Care (CMC) model is an evidence-based care model that positively influences the health and well-being of women, their families, and midwives. Although effective communication strategies have not been determined, online resources are known to reach a wider audience and make CMC research more visible. The All-you-need-to-know-about-continuity-of-carer newsletter, distributed by the authors, is a strategy to communicate valuable and credible CMC content from knowledge producers to users. Purpose: To explore the newsletter's functional elements and the connection between it as a communication strategy and the individuals interacting with it and to present a case demonstration of a newsletter example. Methods: A descriptive case report with a theory-driven approach using 10 elements of human communication theories. Conclusions: The following elements of human communication contribute to understanding the functioning of the newsletter: Grounded Theoretical Theory, the Practical-Action Theory and goal-oriented communication (communication theory), the Syntactic Theory of Visual Communication and the rhetorical tradition of communication (tradition of communication), Elaboration Likelihood and the socio-cultural model of communication (communicator), implied compliance-gaining, parole, semiosis, narrative paradigm and rhetoric logic (message), social organisation communication, co-cultural communication and invitational rhetoric (conversation), the orientation and exploratory affective exchange stages of social exchange (relationship), Structuration Theory (group), the Theory of Bureaucracy (organisation), the Cultivation Theory (media), and the Diffusion of Innovation and Ethnography of Communication (culture and society). Implications: The newsletter succeeds in managing CMC information and reaching an interested audience. Further evaluation is required to explore if or how the newsletter affects information use.

Keywords

case report continuity of care human communication theory midwifery newsletter

Implications for Practice, Research, or Policy

In the Continuity of Midwife Care (CMC) model, the midwife is the lead professional in planning, organising, and providing care, from the first encounter to the postnatal period, in a multi-disciplinary network of consultation and referral with other care providers.

Elements of human communication theory provide a set of understandings that helps our audience weigh alternative courses of action, provokes reflection and insight into dilemmas, and/or suggests new, constructive ways of interpreting situations.

The newsletter brings to the fore an array of components of communicative interaction, including participants, channels, research, and researchers; these forms and patterns of communication have meaning because they give rise to the identity of CMC, creating a sense of community.

Continuity of Midwife Care (CMC) is an evidence-based care model that positively influences the health and well-being of women and their families (Sandall et al., 2024). Continuity of care has been at the heart of maternity policy in the United Kingdom since 1993 with the publication of Changing Childbirth and an emphasis on Choice, Continuity, and Control (Expert Maternity Group, Cumberlege, J. & Great Britain Department of Health, 1993). Scotland's The Best Start report (The Scottish Government, 2017) identified continuity of midwife care as the cornerstone for developing maternity services across Scotland. England's Better Births report highlights the importance of continuity of midwife care, to ensure safe care based on a relationship of mutual trust and respect in line with the woman's decision (National Maternity Review, 2017). Similar movements have been observed globally (Bradford et al., 2022; McInnes et al., 2020). In the CMC model, the midwife is the lead professional in planning, organising, and providing care to a woman from when the woman presents for care during pregnancy to the postnatal period in a multi-disciplinary network of consultation and referral with other care providers. Care is provided by the same midwife or a small team of midwives, aiming to develop a partnership during the perinatal period (Sandall et al., 2024). The principles underpinning CMC are being cared for by a known, trusted midwife or midwives, optimising bio-psychosocial processes, and strengthening the opportunities for women to achieve a positive birth and positive perinatal care experiences (International Confederation of Midwives, 2023). Studies by Dawson et al. (2018) and Fenwick et al. (2018) found that midwives thrived when practising the CMC model, reporting high levels of job satisfaction and well-being. They acknowledged that CMC is the gold standard in maternity care and represents the midwife's identity. The World Health Organization (2018) and the International Confederation of Midwives (2023) recommend CMC as the childbearing woman's first care choice. CMC as a care model is being implemented worldwide, albeit with diversity and constraints in its utilisation (Bradford et al., 2022; Kuipers, 2024; McInnes et al., 2020).

Despite the evidence that this model of care is superior in terms of health outcomes for mothers and their families, information resources are needed to influence the reasoning and beliefs of stakeholders to embrace the operational CMC implementation actively and to support foundational change (Kuipers, 2024; McInnes et al., 2020). Knowledge and knowledge translation are facilitators for the ongoing communication of the CMC model by the current and future midwifery workforce. To support change, build CMC capacity, and increase positive CMC attitudes, regular distribution of foundational material, seminal work, and best practices to student midwives, practising midwives, and other stakeholders (e.g., policymakers, midwifery managers, medical professionals, educators) will facilitate the dissemination and synthesis of theoretical knowledge, research, and critical thinking (Bartholomew Eldridge et al., 2016; Mortensen, 2017; Sibley et al., 2020). The most often used route to disseminate key research findings is publishing these in international peer-reviewed journals, the academic community usually being the audience. Other communication strategies for reaching a wider audience and making the research more visible, specific to CMC have not been determined. Online communication has been identified as an effective strategy (Sibley et al., 2020). The authors sought a strategic and consistent way to communicate, aiming to provide regular updates and information about CMC by carefully selecting credible and valuable content and resources (Mortensen, 2017).

Practitioners and students often perceive research as theoretical or abstract; they perceive a lack of access to information resources and exhibit low confidence and skills in interpreting and translating evidence-based information into clinical practice (De Leo et al., 2019; Ebenezer, 2015). Therefore, attaining and translating evidence into practice remains poor (Corr, 2018; De Leo et al., 2019). The authors sought a way, a freely available and easily accessible medium to communicate CMC research to bridge the gap between knowledge producers and knowledge users (De Leo et al., 2019). A newsletter, a comparatively informal communication medium to inform a certain group, was chosen as the best option. Using newsletters as a corporate communication method is easy: once written they are quickly distributed to a group of recipients with the main purpose of informing. Newsletters are widely used to process relevant, specifically selected and constructed information (Verčič & Špoljarić, 2020).

Purpose of the Newsletter

Although the dissemination of information is intended to serve both ideological and scholarly purposes, the authors aimed to understand the functional elements of a newsletter as a CMC communication strategy and the connection between it and individuals interacting with it—underpinned by a process-driven rationale:
The current diverse and constrained utilisation of CMC despite its sound and vast evidence base.

The need to communicate about CMC.

The gap between CMC research, practice, and education.
Although the newsletter is contextually bound within the paradigm of maternity services, this article is a case report of a newsletter example and aims to use its findings to make suggestions for generalisation (Detlor, 2010; Hyett & Dickson-Swift, 2014; Levine & Markowitz, 2024).

Theoretical Framework

Our theoretical framework consists of selected elements of various human communication theories as presented in Littlejohn and Foss (2011), strengthening the explanatory capacity of this case report (Barnett et al., 2016). The theoretical framework facilitates conceptualising the case cohesively and logically and strengthens the findings and interpretations (Detlor, 2010; Levine & Markowitz, 2024). Our framework includes the following ten elements as preliminaries to human communication: communication theory, the tradition of communication, communicator, message, conversation, relationship, group, organisation, media, culture, and society (Littlejohn & Foss, 2011). The perspective and elements of human communication represent the transactional process of interacting, learning, and relationships, which are congruent with the rationale of this case study.

Methods

This paper presents a descriptive case report of the All-you-need-to-know-about-continuity-of-carer newsletter. The newsletter was funded and launched in February 2023. A descriptive case study approach was chosen because it is structured to help identify emerging patterns of one example based on a solid theoretical framework interpreted by the researcher (Crowe et al., 2011; Detlor, 2010; Yin, 2009).

Process

We executed a linear process that involved moving between the theoretical framework presented by Littlejohn and Foss (2011), organising and constructing case information, and analysing how this information related to the ten theoretical elements that defined the study's boundaries (Yin, 2009). The study's methodological approach integrates how the newsletter's editorial group/authors perceived the newsletter based on the theoretical framework. The informants present intra-case information: knowledge about the work and tasks and how these are accomplished, drawn from their expertise in developing the newsletters’ content and format and writing, discussing, producing, and distributing the newsletters. External data sources were Microsoft/social media analytics, peer-reviewed papers that describe the CMC model, documents focusing on knowledge translation into practice and education, and the Edinburgh Napier University's application form that the authors had submitted to request funding. The external sources were selected because of their prominence in contributing to a better understanding and interpretation of CMC and knowledge translation, their accessibility and availability, IT infrastructure, and the interests of the audience (i.e., student and practising midwives, policymakers, midwifery managers, medical professionals, educators) (Rowley, 2002; Yin, 2009). All authors familiarised themselves with the elements of human communication described by Littlejohn and Foss (2011).

Analysis

The analysis began with questioning how each theoretical framework element was recognised in the intra-case information and external resources. Each relevant piece of information was filed under the appropriate element. Then, the ordered information was inductively examined by YK, YG, and GN, who examined the information for relevance, appropriateness, completeness, and element congruence. At this stage, information was moved, removed, recombined, and added (Yin, 2009). The results were discussed among the authors, reaching a consensus, and synthesis statements were drafted for each theoretical element.

Case Presentation

The editorial group, consisting of three early- and mid-career researchers, was established. We identified the relevant activities and prepared a work plan. One group member drafts the newsletter, which is then reviewed and discussed by the editorial group before it is produced and distributed. The topics are chosen to reinforce the midwife's behavioural utility of the CMC model described by Kuipers et al. (2023) and to address the underreported topics of CMC. Nine newsletters are produced and distributed each year. CMC-related papers published in English from all countries can be included in the newsletter.

Newsletter Content

Each newsletter showcases one published article by reformatting it in a summary. Each newsletter follows the same structure:

Summary of the Study, including the study design, population/sample, measures, and findings.

Implications for Practice. We utilise this information when reported in the study; otherwise, we consult the author(s) or discuss the implications as an editorial group.

Interview With the Author(s), allowing them to discuss the study in more depth (its meaning and the researcher's experiences) and to add information. We talk about their learning/insights, and if and how the study impacts their practice, development, learning, and/or academic work. The interview often provides input for Thoughts to Consider.

Citation for the Study. We provide the American Psychological Association (APA) citation of the study, along with the published article's digital object identifier (DOI).

Thoughts to Consider, including questions for reflection, formulated after the editorial group discussion.

Masthead, including the editorial group, their contact information, Edinburgh Napier University as the publisher of the newsletter, social media links, and funding information.

The newsletter's content is imported into the Microsoft Sway^© app to finalise production.

Disseminating the Newsletter

Each newsletter has a unique link, shared via JISCm@il (an international email discussion list for research and education advancement, knowledge exchange, and collaboration), Edinburgh Napier University's intranet systems (closed online student and staff communication), networks of the authors, and Facebook. The networks use group email security, maintaining the privacy of individual subscribers. Individuals can respond, unsubscribe, and/or share the newsletter's link within their (external/social media) networks, allowing snowballing. The newsletter's Facebook presence is a closed group and is General Data Protection Regulation (GDPR)-compliant regarding consent and data sharing. Members can respond to the newsletter posts using emoticons (regulated in the settings) and share the newsletter's link via other platforms or groups. The newsletters are stored as PDF files on Microsoft Teams^©, along with the papers/studies highlighted in the newsletter, creating an archive for CMC educational purposes. We only store free text articles or those accessed via the University's library subscriptions. The archive is accessible to midwifery lecturers at Edinburgh Napier University. Flyers, posters, and promotional material are used to disseminate the newsletter and to draw attention to the newsletter at events such as conferences or meetings. Flyers and posters include QR codes to sign up for the newsletter on social media. We anticipated student midwives, practising midwives, and other maternity care professionals (e.g., obstetricians, nurses), policymakers, managers of maternity services, pregnancy/birth instructors, researchers, educators, and service users as our target audience. We anticipated reaching an international audience, although we only included the content in one language: English, the most spoken language worldwide.

We aimed to provide an easy-to-use and freely available platform to disseminate and promote evidence-based CMC information to contribute to a positive CMC culture, including the following objectives:
Engage with the CMC evidence and share CMC information, knowledge, initiatives, experiences, best practices, and accomplishments.

Translate academic reports into plain language.

Complement other communication and dissemination tools (such as journals, and conferences).

Engage with midwifery education.

Synthesis: Findings and Interpretation

Communication Theory

When we applied for funding, we justified the need for the newsletter by articulating a vision for the development of a desirable future condition or situation for CMC—envisaged to attain and as the plausible course of action to be taken for its achievement (Kuipers, 2024). A shared vision arouses aspiration and creates the spark that lifts individuals and communities out of their usual way of doing things and/or instills courage and determination to rise to challenges. Knowledge was identified as one of the facilitators for the ongoing implementation of the CMC model by the current and future midwifery workforce (McInnes et al., 2020). Therefore, peer-reviewed articles in academic journals are searched and selected. CMC is a research area of the Edinburgh Napier University's Midwifery Subject Group, and hence researchers engage with CMC-related literature. Researchers suggest studies to the editorial group; sometimes, emails are received from authors proposing their papers. The newsletter also showcases the University's research group's publications. The selection criteria are that the paper must provide constructive information to contribute to CMC practice. The editorial group discusses potential papers, aiming for a variety of topics.

Our newsletter includes scientific scholarship, objectively and methodically looking at and explaining the world and humanistic scholarship, eliciting individual subjective responses from the readers. The newsletter responds to queries, observations, thoughts, and insecurities that can serve as a medium to advance the theoretical knowledge and understanding of stakeholders engaging with or interested in CMC. The newsletter conveys the available evidence by defining, describing, explaining, and interpreting it, potentially leading to new enquiries (Littlejohn & Foss, 2011, pp. 9–10).

Grounded Practical Theory underpins the vision of our newsletter. Grounded Practical Theory recognises three levels: (1) the problem level, (2) the technical level, and (3) the philosophical level (Craig & Tracy, 2014). The problem level refers to non-academics not actively accessing research information (Corr, 2018; Ebenezer, 2015; De Leo et al., 2019). The structure of our newsletter serves as a solution for this dilemma (technical level), which the authors perceive as an ideal communication tool to manage the CMC communication problem (philosophical level). Providing a set of understandings helps the newsletter's audience to weigh alternative courses of action, provoke reflection, or suggest new constructive ways of interpreting situations (Baige & Craig, 2009). Interviewing the author(s) and portraying them as affected by the realities they cover in their studies, is consistent with the Practical-Action Theory as this emphasises that theorists or researchers are not separate from the world (Berger & Luckmann, 2016). The newsletter's implications section is congruent with goal-oriented communication, empowering the audience to understand what is happening and to make choices and act, including actions that may override the predominant rules and norms of practice in maternity services (Goldreich et al., 2012). The newsletter incorporates the principle of reflection, to reflect on actual practice by addressing the implications of the study's findings in the newsletter (Littlejohn & Foss, 2011, p. 32).

Tradition of Communication

Each newsletter includes the same (freely available, free of royalties) photo of a smiling woman wearing a hospital gown or nightgown, lying in a hospital bed with a smiling female care professional (recognised as such because she is wearing scrubs), sitting on the bed next to her. The care professional has her arm around the woman and their heads touch. The picture suggests spontaneity, positivity, and warmth. The picture portrays two people who appear comfortable in each other's company, obviously familiar with each other. The women are positioned next to each other, suggesting equality. Because of a certain togetherness, the implied meaning of the picture is a bond of trust between these two women. A close, trusting, reciprocal relationship is pivotal in CMC (Kuipers et al., 2023).

The photo is a symbolic representation of CMC, holding equal significance with words in the communication process. It connects the visual element with the written content of the newsletter, offering cues that define CMC on an international scale. These elements are consistent with the Syntactic Theory of Visual Communication (Lester, 2019). The repeated use of the photo as a symbol of CMC is communication appealing to emotions and logic to motivate or inform the international audience about CMC, a culture-specific way of framing and understanding CMC arguments, consistent with the rhetorical tradition of communication (Tanno & González, 2000).

The Communicator

The newsletter includes theoretical and practical application of relevant knowledge by summarising each selected research paper, addressing the implications of the study findings and formulating “thoughts to consider”—supporting critical thinking, analysing, synthesising, and evaluating information, developing content knowledge, and instigating argument and enquiry. Interviewing the author(s) of the study and allowing them to elaborate on it, accommodates the portrayal of evidence, expertise, individuality, and opinion. The information in the newsletter conveys consistently clear and positive valence of information—supporting the positive outcomes of CMC. The newsletter's construct of “thoughts to consider” is included to aid the audience in thinking about whether the study's findings are consistent with their perceptions or practice. The communication is a one-way process, from the editorial group to the audience. The Microsoft Sway^© newsletter template facilitates a feasible cognitive load of the newsletter's constructs (summary, implications for practice, interview with the author(s), and thoughts to consider). The editorial group members are midwives, educators, and researchers. Their names, prefixes, and email addresses are included in the newsletter. They all have a track record of peer-reviewed publishing and speaking at conferences. The authors of the selected studies are usually well-known among the CMC audience.

In congruence with the aim and mission of the newsletter, the chosen studies, in combination with allowing the author(s) a voice, employ a persuasive communicator role, including communicator cues, context cues, and message cues, in line with Elaboration Likelihood—the probability of evaluating the information critically (Bartholomew Eldridge et al., 2016). Because of the robust evidence of the positive effect of CMC but its diverse and constrained utilisation (Bradford et al., 2022; Kuipers, 2024), the newsletter might not only contribute to making sense of CMC but also to cognitive dissonance depending on where the reader is situated or practising. The author(s) of the studies and the editorial members are known to the audience (through publication or teaching) or to be easily searched, showing their membership in the midwifery research community, acting as agents of CMC—consistent with the social-cultural model of communication (Ristino, 2008).

The Message

The newsletter's title: All-you-need-to-know-about-continuity-of-carer conveys that everything one needs to know about CMC will be achieved through reading the newsletter. Each newsletter includes written text, summarising the study and describing its implications but not using the original text of the paper, instead conveying the constructs’ key messages in plain language, as opposed to research and statistical semantics often included in academic papers. Each newsletter follows the same pattern of constructs, the same variation of typography, fonts, shapes, and colours, including the same photo. The colours of the headings, subheadings, and shapes are blue, like the colours of the Royal College of Midwives (RCM) in the United Kingdom (UK). The newsletter's draft version is read and discussed by the editorial group members. After interviewing the author(s), the interview script to be included in the newsletter is read, validated, and consented to by the author(s) before the newsletter is published. Topics of newsletters so far are care behaviour, satisfaction and well-being of midwives working (part-time) in a CMC model, implementation and sustaining the CMC model, the number of midwives involved in a CMC model, effects of CMC on birth and maternal outcomes and experiences, leadership, and online CMC. Authors shared thoughts about the management, leadership, and organisation of CMC, accessibility of the model, attitude towards CMC, drivers for being and/or becoming a CMC midwife, CMC in a multidisciplinary context, and the woman–midwife relationship.

The newsletter's title has an implied compliance-gaining message (Wheeless et al., 1983), defining the newsletter as valuable to read, emphasised by the phrase: “all you need to know.” In the newsletter, content knowledge takes centre stage, enhanced by routines. The editorial group adapts the academic language in a less formal system of speech or parole to support cognition and discourse (Nöth, 2014). Semiosis, or the use of nonverbal codes (such as iconicity, universal meaning, and illustration) is employed to represent the written text and to persuasively convey the message's meaning (Nöth, 2014). Discussing the newsletter among the editors emphasises the hermeneutic circle through ongoing interpretation and composite meaning of the text. Involving the study's author(s) enhances narrative fidelity, consistent with the narrative paradigm (Fisher, 1987). The repeated use of the same construct and style of the newsletter constitutes a rhetorical logic that supports the reception of the CMC message (Varpio, 2018).

The Conversation

The newsletter includes the social media link where the newsletter is shared. Occasionally, readers post positive responses (emoticons such as a smiley or thumbs up) about the content on social media. So far, no negative responses have been posted or emailed. Reader engagement analytics indicate that views have risen from around 300 initially to over 6000 per newsletter and that the audience engages with each newsletter for 1–2 min. The newsletter has been externally shared by the Dutch Organisation of Midwives and the Scottish Midwifery Led Network. Views significantly increase after each newsletter and each time the dissemination resources are widened. Print copies, flyers, posters, and promotional material were disseminated at a Scottish health board conference (November 2023), several National Health Service (NHS) maternity units in Scotland, and two CMC research workshops (April 2024). From recorded responses, we know we have readers from Europe, Australia, Asia, and North America.

The growing audience mirrors a reciprocal interaction pattern of requirement (the newsletter) and expectation (views/audience), connecting individuals and groups, known as social organisation communication (Santra & Giri, 2009). The time the audience engages with the newsletter represents an appropriate quantity maxim, maximising engagement (Grice, 1975) because reading a newsletter thoroughly takes more than 51 s (Nielsen, 2010). A wider circulation and visibility of the newsletter suggests that CMC plays a role in building and/or maintaining a shared consciousness among midwives about a care model that is not dominant in a medical care system (Kuipers, 2024), consistent with co-cultural communication (Orbe, 1998). Sharing the newsletter via group email and social media implies the CMC message is offered to the audience who is free to consider the CMC perspective, consistent with invitational rhetoric (Foss & Griffin, 1995).

The Relationship

The newsletter includes the email addresses of the editorial group members. The author(s) can come from any country; as of this writing, authors have been from the UK, the European continent, and Australia. The interviews with the author(s) have been conducted in English and Dutch (the first author's native language). The interview is a dialogue, sometimes with predefined questions but usually a free-flowing conversation. The dialogue takes place online and lasts between 30 to 60 min. The dialogue is recorded with permission of the author(s), and notes are made. The newsletter includes the invitation to share studies as researchers are among the audience, extending the network.

The email addresses of the editorial group members represent the orientation stage of social exchange and the interview with the author(s) is the exploratory affective exchange stage (Altman & Taylor, 1973).

The Group

With the newsletter, we bridge the gap between knowledge producers and knowledge users and challenge the research barriers (Corr, 2018; De Leo et al., 2019). We take leadership in CMC research translation and dissemination as there are no similar initiatives as the All-you-need-to-know-about-continuity-of-carer newsletter. The editorial group works as a team of a professor, associate professor, and senior lecturer—all holding a doctoral degree—in collecting articles, editing, compiling, and preparing a draft of the newsletter and collaborating with key (inter)national researchers. The editorial board invites (doctoral) researchers and students to participate in newsletter activities to support their development as researchers by selecting an article, drafting a newsletter, and interviewing an author. The newsletter is distributed to an international diverse multi-actor audience, including policymakers, managers, researchers, lecturers, health-care professionals, service users, and childbirth educators but the audience is mostly practising- and student midwives. The audience can respond on social media.

Four human interaction systems are present: the editorial group system, the editorial group and author(s) system, the editorial group and the audience system, and the author(s) and the audience systems. Structures and networks are formed ranging from social relations to institutional relations, interacting in mutually constituting ways (Chatterjee et al., 2019). These mechanisms are part of the Structuration Theory (Giddens, 1984).

The Organisation

The newsletter was originally funded by a Higher Education Institution (HEI). Each newsletter includes a notification about the funder (Edinburgh Napier University). To sustain the newsletter after HEI funding was discontinued (in July 2023), the editorial group members make time for newsletter activities within their workload allocation. The editorial group uses the logistics and resources of the Edinburgh Napier University (e.g., Microsoft Sway^© account, photocopying, secure email system, library). The editorial group is part of the Edinburgh Napier University's midwifery subject group which has a history of conducting CMC research but also teaches CMC and has close connections with midwifery practice and through organisations such as the Nursing and Midwifery Council (NMC) and the RCM, and thus are familiar with the professional identity and performance of (student) midwives (McLuckie & Kuipers, 2024).

HEI are symbolically achieved cooperations, cultures, and systems. A sense of organisational authority is evident because the editorial group is situated within the University and is embedded in co-oriented CMC activities and a formal multi-actor network with multiple HEI functions including standardised administrative processes (Olsen, 2005)—as described by the Theory of Bureaucracy (Weber, 1968).

The Media

The first newsletters were distributed among (online) networks of the editorial team such as JISCm@il and the university's intranet. The audience increased through snowballing. Microsoft Sway^© does not require advanced IT skills and the Microsoft Sway^© newsletters are easily shared on social networks by built-in icons (Facebook, LinkedIn, Twitter/X). The Edinburgh Napier University's Marketing & External Relations Department shared the newsletter on their X /Twitter) page (15.000 followers).

The forms of media are recognised as agents bringing about a shared way of viewing CMC, to cultivate and mainstream a CMC culture. This is recognised within Gerbner et al.'s Cultivation Theory (1986).

Culture and Society

The newsletter addresses the midwifery culture. We inform a large network showing an interest in CMC—likely individuals in practice, education, and/or management. Additionally, the newsletter serves as a platform for researchers. When beginning the newsletter, we knew that practitioners and students may perceive research as “daunting” or “alien” and that the link between research and practice is not always obvious (Corr, 2018; Power & Ridge, 2017). Additionally, we were aware that researchers are assigned stereotypes, such as superiority, and hierarchical behaviour (Carli et al., 2016; Demirbilek et al., 2022). By interviewing the author(s) and discussing their learning, reflection, thoughts, and experiences, researchers become persons, individuals to whom readers can relate. As one of the authors said during an interview: “We are real people, sharing a passion.” The university's midwifery master's program offers students the opportunity for an elective research placement. Student involvement in the newsletter is part of this placement, including joining the interviews and formulating questions for the author(s).

The author(s) or researchers are recognised as opinion leaders and/or change agents, who have a functional impact as recognised in the Diffusion of Innovation Theory (Bartholomew Eldridge et al., 2016). The newsletter brings to the fore an array of components of communicative interaction, including participants, channels, research, and researchers (Noy, 2017). These forms and patterns of communication have meaning because they give rise to the identity of CMC, creating a sense of community—consistent with the Ethnography of Communication (Hymes, 1964).

Discussion

This descriptive case report is structured according to theoretical principles and attempts to explain why the newsletter initiative has enjoyed a promising start. We have investigated the key facts and gained greater insight into the different dimensions of the newsletter. The framework of human communication as the theory-driven approach of our case report—including communication theory, the tradition of communication, the communicator, the message, the conversation, relationship, group, organisation, media, and culture and society. We gained a broader appreciation of the newsletter product and process. (Crowe et al., 2011; Detlor, 2010; Yin, 2009). The newsletter is an example of the management of the process and system that creates, acquires, organises, transmits, stores, and uses structured information in a meaningful, strategic, and useful context (Detlor, 2010). Information management using technology plays an integral role (Detlor, 2010). We brought a construction of reality (i.e., the authors’ experiences and expertise) to the case report, the interpretations being filtered through the lens of the newsletter's editorial group (i.e., the authors) (Yazan, 2015). Our theory-driven approach has resulted in a more informed appreciation of how and why the newsletter works as a communication medium serving as a knowledge nudge (Sibley et al., 2020; The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG), 2006). Given the rise in newsletter views suggesting the increase of individuals reading the newsletter, we believe the CMC newsletter fits within the midwifery culture and has a salient value—a sense of the important ends and means—which may be related to the importance of the news, the importance of diffusing CMC to the audience and the “awareness-knowledge” of the audience (Rogers, 2000, pp. 569–570). This suggests that our audience is interested in CMC despite its diverse and constrained utilisation (Bradford et al., 2022; Kuipers, 2024), likely meeting an information need of the CMC stakeholders (Rogers, 2000). The relationship between the editorial board, the authors, and the audience all seem to come together to form a deep structure that reflects and influences the sense of CMC reality (Mortensen, 2017).

Limitations

This case study describes the development of a newsletter for the midwifery domain, but the generalisability of the results to broader populations is limited. The article describes the structural elements of the newsletter and the process of newsletter development; however, replicating the exact methods or achieving the same results may be difficult due to the unique experiences of the authors of the various articles within each case. We have manifested our identities as educators, midwives, and researchers, and our frame of reference was CMC and the interpretation of the theoretical elements (Crowe et al., 2011; Yazan, 2015); this could have introduced bias during information collection and synthesis (Yin, 2009). Further evaluation of the newsletter is required, not only regarding its content, structure, format, or dissemination frequency but also if or how the newsletter contributes to learning and knowledge, translating the information into practice, making changes, and gaining a better understanding of the character of our audience—who are they—and exploring if certain topics receive more views (Detlor, 2010; Sibley et al., 2020).

Conclusion

We have gained a prime understanding of the All-you-need-to-know-about-continuity-of-carer newsletter's functional elements and the connection between the newsletter as a communication strategy and medium and as a network of individuals interacting with it. Various theories and theoretical elements contributed to the understanding of the functioning of and the interaction with the newsletter, such as Grounded Theoretical Theory (Craig & Tracy, 2014), the Practical-Action Theory (Berger & Luckmann, 2016) and goal-oriented communication (Goldreich et al., 2012) (communication theory), the Syntactic Theory of Visual Communication (Lester, 2019) and the rhetorical tradition of communication (Tanno & González, 2000) (tradition of communication), Elaboration Likelihood (Bartholomew Eldridge et al., 2016) and the socio-cultural model of communication (Ristino, 2008) (communicator), implied compliance-gaining (Wheeless et al., 1983), parole (Nöth, 2014), semiosis (Nöth, 2014), narrative paradigm (Fisher, 1987) and rhetoric logic (Varpio, 2018) (message), social organisation communication (Santra & Giri, 2009), co-cultural communication (Orbe, 1998) and invitational rhetoric (Foss & Griffin, 1995) (conversation), the orientation and exploratory affective exchange stages of social exchange (Altman & Taylor, 1973) (relationship), Structuration Theory (Giddens, 1984) (group), the Theory of Bureaucracy (Weber, 1968) (organisation), the Cultivation Theory (Gerbner et al., 1986) (media), and the Diffusion of Innovation (Bartholomew Eldridge et al., 2016) and Ethnography of Communication (Hymes, 1964) (culture and society).

The newsletter addresses information needs, information organisation, and developing and distributing information about CMC. Further evaluation is required to explore if or how the newsletter affects information use.

Footnotes

Acknowledgements

The All-you-need-to-know-about-continuity-of-carer newsletter was funded by Edinburgh Napier University's Researcher Development Fund (2022–2023).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Edinburgh Napier University Researcher Development Fund [grant number N253-000, 2023].

Ethics

Ethical approval was not relevant to the manuscript.

ORCID iD

Yvonne J Kuipers

Author Biographies

Yvonne J. Kuipers, PhD, (she/her), is a Professor of Midwifery in the School of Health and Social Care at Edinburgh Napier University. She has a background that has encompassed a career in women's reproductive health that spans over 20 years in the Netherlands, Belgium, and Scotland.

Yvonne Greig, PhD, (she/her), is a Midwifery lecturer in the School of Health and Social Care at Edinburgh Napier University. She aims to develop research, ensuring the provision of robust educational opportunities for the midwifery workforce.

Gail Norris, PhD, (she/her), is an Associate Dean International and a Senior Teaching Fellow in the School of Health and Social Care at Edinburgh Napier University.

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Human Communication Elements of the Continuity of Midwife Carer Newsletter: A Descriptive Case Report

Abstract

Keywords

Implications for Practice, Research, or Policy

Purpose of the Newsletter

Theoretical Framework

Methods

Process

Analysis

Case Presentation

Newsletter Content

Disseminating the Newsletter

Synthesis: Findings and Interpretation

Communication Theory

Tradition of Communication

The Communicator

The Message

The Conversation

The Relationship

The Group

The Organisation

The Media

Culture and Society

Discussion

Limitations

Conclusion

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

Ethics

ORCID iD

Author Biographies

References