Developing Rapid Realist Methods for Evaluating Accountability Frameworks in Maternity Services(code R1.1_Birmingham)

The National Institute for Health and Care Research (NIHR) Inequalities Challenge: Maternity Disparities Consortium (MDC) is proud to announce its PhD Studentship competition. We are seeking the next generation of researchers to help us tackle persistent inequalities in maternity. 

The MDC brings together a UK wide collaboration of universities, NHS trusts, councils, charities, and industry partners. You can find information about our consortium members here. Our goal is to improve outcomes for women and babies before, during, and after pregnancy through inclusive, evidence-based research. 

Capacity Development

The MDC capacity development programme aims to build the next generation of maternity disparities research leaders, strengthen the workforce to deliver and sustain impact across the UK and deliver on the government priorities including the Women’s Health Strategy for England and 10 Year Health Plan for England.  

The Consortium focuses on growing long-term research capacity and expertise, especially within underrepresented disciplines, professions and underserved communities; inspiring and supporting the next generation of researchers with the right skills mix to work across clinical, practice and research sectors.  

The Opportunity

We are offering up to 13 funded PhD studentships across a range of potential projects at universities across our Consortium. We are specifically looking to grow research capacity in methodological areas, including but not limited to, health economics, statistics, trial design, digital research, data science, implementation science and co-production methods where expertise is currently limited. 

Start: January 2027 

Duration: Up to 3 years (Full-Time) or 4 years at 0.8WTE (Part-Time) 

Funding:  

• Full home tuition fees covered (at 2026/27 UK rates). 
• Tax-free annual stipend at UKRI rates (£21,805/£23,805 outside London/ inside London from 1^st October 2026). 
• £5,000 (per award) contribution towards research, travel, training and consumables. 
• International students are welcome to apply but must secure alternative funding for the difference between UK and Overseas tuition fees.

The Project

Accountability frameworks are increasingly used within healthcare to improve quality, safety, equity and organisational performance. These include governance arrangements, quality assurance processes, regulatory mechanisms, learning systems, equity action plans and performance monitoring frameworks. Despite widespread implementation, evidence regarding how accountability frameworks work, for whom, in what circumstances and through which mechanisms remains limited.

Maternity services provide a compelling empirical lens through which to develop and refine rapid realist evaluation methods. The sector is characterised by the rapid rollout of policies, governance reforms and accountability initiatives in response to national safety reviews and persistent racial disparities in maternal outcomes. These dynamic and complex organisational environments require evaluation approaches that can generate timely explanations of how accountability mechanisms function, rather than simply whether they achieve intended outcomes.

Patient and Carer Race Equality Framework (PCREF) is an NHS anti-racism accountability framework for mental health services. It is the first mandatory anti-racism framework which is expanding into maternal and perinatal care pathways from 2025/26. The PCREF focuses on 3 areas:

Leadership and governance – trust boards will lead on creating and monitoring plans to reduce health inequalities.

Data – trusts must publish new data on progress in reducing health inequalities, and include ethnicity information in all existing core data sets.

Feedback – trusts must put clear, visible ways in place for patients and carers to give feedback, and show how that feedback leads to action.

This research aims to develop, and test a method for conducting rapid realist evaluations of accountability frameworks in maternity healthcare systems. This is important as realist evaluation offers an approach to understanding complexities by identifying Context-Mechanism-Outcome (CMO) configurations. However, full realist evaluations are resource intensive and may take several years to complete, limiting their usefulness for policymakers and healthcare organisations requiring timely evidence to assess the efficacy of newly rolled out programmes.

Co-produced with stakeholder and community engagement, this project will; 1) identify and assess the efficacy of existing realist methodologies and rapid methodologies which adopt realist approaches, 2) collate the facilitators, barriers and recommendations to delivering rapid realist methods, 3) through qualitative assessment, develop methodological outputs including guidance, implementation tools and recommendations, and 4) test the explanatory power and equity alignment of the methodological output with assessment of the PCREF in perinatal mental health services.

Developing rapid realist methods in this context will produce methodological advances with relevance across healthcare while addressing a pressing need for evidence to support equitable and accountable maternity care. This will help identify early indicators of successful implementation and has the potential to improve women’s lives by strengthening the evidence base for accountability in maternity services.

Contact Supervisor – Michelle Fisher, [email protected]

Who is a MDC PhD studentship for? 

We welcome applications from individuals passionate about maternal health equity with particular methodology knowledge and experience. We are committed to building a supportive, inclusive, and caring research community. We particularly encourage applications from: 

• People from underrepresented ethnic backgrounds. 
• People with disabilities, neurodivergent conditions, and long-term health requirements 
• Candidates of all genders, ages, and beliefs. 
• We encourage applicants with experience of a wide range of methodologies to apply if they believe they can bring valuable skills to research on maternity inequalities. If it is not immediately obvious, please use your cover letter to explain how your disciplinary background will allow you to carry out your research. 

Eligibility Criteria

Essential

• A Master’s degree in a relevant field (epidemiology, global health, medical science, public health, applied health, social science, psychology) or significant relevant clinical experience (midwifery, MBChB etc.).
• Understanding of and commitment to tackling maternity inequalities. 
• Relevant previous research experience – this experience may be relevant to either the research or methodological area. 
• Excellent written and verbal communication skills. 
• Highly motivated. 
• Able to work both independently and as part of a team. 
• Able to plan and manage own work. 
• International applicants are welcome to apply for studentships, but applicants who are selected for interview must be able to provide proof of funding for international fees and immigration costs prior to their interview.   
• Where English is not your first language, you must show evidence of English language ability to the following minimum level of proficiency: an overall IELTS score of 7.0 or above, with at least 6.5 in each component or an accepted equivalent. Please note that your test score must be current, i.e. within the last two years. The only exception to the above would be if applicants can provide a Master’s certificate completed in a UK institution with an outcome of merit or distinction, taken within the last two years.

Desirable

• Experience of conducting qualitative or mixed-methods research.
• Demonstrable interest in health inequities, maternity care, realist methods, implementation science, healthcare evaluation or organisational change.
• Strong stakeholder engagement skills.

*All students will be expected to be based at their host university and meet the individual university PhD studentship regulations. Please check individual university postgraduate admissions.

Accessibility and Support

We want you to perform at your best. You may contact individual supervisors when asking for more details about the projects and your suitability for the project. General enquiries about the recruitment process and MDC, including if you require any reasonable adjustments for the application process or the interview (such as alternative formats, extra time, or specific technological needs), please contact:  [email protected].  

NIHR and DHSC have a duty as a public body to promote equality of opportunity.  We will contact all applicants throughout the application period with an Equality Monitoring Form. Monitoring ensures that all applications to NIHR MDC Programmes are treated equally in terms of gender, ethnicity and/or disability. Information will be anonymised and stored separately from your application, only be used for the purpose of monitoring equal opportunities and be kept securely and in confidence.