From equity to power: Critical Success Factors for Twinning between midwives, a Delphi study

Franka Cadee*, Marianne J. Nieuwenhuijze, Antoine L. M. Lagro-Janssen, Raymond de Vries

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)


AimsTo gain consensus for Critical Success Factors associated with Twinning in Midwifery. BackgroundInternational publications identify midwifery as important for improving maternity care worldwide. Midwifery is a team effort where midwives play a key role. Yet their power to take on this role is often lacking. Twinning has garnered potential to develop power in professionals, however, its success varies because implementation is not always optimal. Critical Success Factors have demonstrated positive results in the managerial context and can be helpful to build effective Twinning relationships. DesignWe approached 56 midwife Twinning experts from 19 countries to participate in three Delphi rounds between 2016 - 2017. MethodsIn round 1, experts gave input through an open ended questionnaire and this was analysed to formulate Critical Success Factors statements that were scored on a 1-7 Likert scale aiming to gain consensus in rounds 2 and 3. These statements were operationalized for practical use such as a check list in planning, monitoring and evaluation in the field. FindingsThirty-three experts from 14 countries took part in all three Delphi rounds, producing 58 initial statements. This resulted in 25 Critical Success Factors covering issues of management, communication, commitment and values, most focus on equity. ConclusionThe Critical Success Factors formulated represent the necessary ingredients for successful Twinning by providing a practical implementation framework and promote further research into the effect of Twinning. Findings show that making equity explicit in Twinning may contribute towards the power of midwives to take on their identified key role.
Original languageEnglish
Pages (from-to)1573-1582
Number of pages10
JournalJournal of Advanced Nursing
Issue number7
Publication statusPublished - 1 Jul 2018


  • Delphi technique
  • empowerment
  • international health
  • leadership
  • midwifery
  • nursing

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