Table 3 Refined programme theory

Women who do not speak English and those who have difficulties communicating (learning or physical disabilities). These women are often unfamiliar with the UK health system.

M1) If women who don’t speak English have access to language appropriate information about how to access a GP and maternity services, and help is given to fill in registration forms

O1) Then access to maternity care will not be denied or delayed through the process of registering for NHS services, and women will feel more supported from the beginning of their care experience.

M2) If women have access to high quality interpreter services during antenatal, intrapartum and postnatal care, education, and are able to book or rearrange appointments and seek help when concerned using translation technology

O2) Then inequity in information received and a key communication barrier will be overcome, women will feel better supported and listened to, be better able to access services and seek appropriate help in a timely manner.

M3) If women are able to request a different interpreter or method of interpretation if they do not feel the interpretation is accurate or confidential

O3) Then the quality of the interpretation can be improved, and women will have more confidence and trust in the persons providing the service, leading to more meaningful communication with the healthcare professional.

M4) If healthcare professionals listen to women’s choices about interpreter services and offer preferred options, for example a female, an anonymous, or a trusted interpreter such as a family member or friend

O4) Then barriers to the use and effectiveness of interpreters will be reduced and women would feel more comfortable discussing sensitive subjects and disclosing concerns with their healthcare provider, improving safety.