Assessing midwives’ communication skills in Cyprus using the HP-CSS Tool: A mixed-methods study

Abstract Background It is essential for midwives to recognize the role of effective communication in maternity care. While observation tools are often used in clinical education, self-assessment tools like the Health Professionals’ Communication Skills Scale (HP-CSS) have been developed for research. The study (a) assessed the content and construct validity of the Greek HP-CSS and (b) explored midwives’ perceptions of communication skills strengths through self- and peer assessment of colleagues as a group. Methods A two-phase mixed-methods design was used. Phase A involved qualitative analysis of written reflections from communication skills workshops to assess content validity of the HP-CSS; Phase B was a quantitative study exploring the tool's construct validity (18 items, 4 sub-scales, scale 1-6) and associations with sociodemographic and professional characteristics. Results Midwives (N-79; 1 in 5 nationally; 47% public sector; 24% >15 years’ experience) rated themselves higher on Respect (M = 5.73) and Empathy (M = 5.51), and lower on Informative communication (M = 5.19) and Social skills (M = 3.90). With the exception of social skills, they consistently rated themselves higher than peers across all items, with a 15-20% difference. Those with postgraduate training rated themselves slightly lower; no other differences emerged. Midwives valued communication (importance/ usefulness means >5.5/6) but acknowledged challenges (feasibility/ease <4.4/6). Qualitative findings supported the tool's content validity with strengths noted in empathy and weaknesses in information gathering and agenda setting. Conclusions The HP-CSS appears to be a useful tool for self- and peer-assessment with metric properties aligned with previous validations. It highlights key strengths and gaps in midwives’ communication and offers a foundation for future training as strengthening communication skills of perinatal healthcare providers supports better maternal and newborn outcomes. Key messages • Midwives in Cyprus self-assess highest in empathy and respect, but acknowledge gaps in social and informational communication. • Validated tools like HP-CSS have research and educational value, fostering reflection and supporting training in diverse clinical settings.