A socio‐ecological approach to understanding barriers to prenatal care for women of low income

Abstract

This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of low income. A socio-ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as a social product and are consistent with the ideology of health promotion.

Socio-demographic disparities in the uptake of prenatal screening and diagnosis in Western Australia

“…24,30,31,40 Psychosocial barriers include being unaware of the pregnancy, lack of knowledge of available services, negative attitudes to health professionals, depression and personal or family problems. 40 System-related barriers include cost, physical access to providers, discrimination and cultural and language barriers. 31,40,41 In Western Australia, FTS providers are generally located in high socio-economic areas and there are few in regional and remote areas.…”

“…40 Situational barriers that often reflect socioeconomic disadvantage include access to transport, childcare and having time away from work. 24,30,31,40 Psychosocial barriers include being unaware of the pregnancy, lack of knowledge of available services, negative attitudes to health professionals, depression and personal or family problems. 40 System-related barriers include cost, physical access to providers, discrimination and cultural and language barriers.…”

Processes and Functions in Higher Education Students Adjusting to a New Learning Environment: Applying The Mmogotm-Method

“…Socio-ecological theory suggests a dynamic interplay between people and their social contexts. Human behaviour is integrated in a dynamic and complex network of intrapersonal issues, interpersonal and community dynamics, institutional persuasions, and public policy (Barker, 1968;Dalton, Elias & Wandersman, 2007;Sword, 1999). This implies that human beings and their communities exert reciprocal influences over each other (Haughton, 2006;Keesing & Strathern, 1997;Larkin, 2004;Sword, 1999), thus contributing to a sense of interdependence between individuals and the contexts in which they function.…”

“…Human interactions influence communities in their construction and application of meanings (Klunklin & Greenwood, 2006). Individual behaviour can either reinforce or discredit socially created meanings that define a community context (Haughton, 2006;Henslin, 1999;Keesing & Strathern, 1997;Larkin 2004;Sword, 1999). Individual behaviour that affirms a community's socially constructed meanings is seen as enabling within the social context where such conduct occurs and is defined (Lynch & McConatha, 2006).…”

Perceived Learning Needs of Minority Expectant Women and Barriers to Prenatal Education

“…The Perceived Barriers Survey was developed by the investigator and based on Sword's (1999) socioecological model of health services utilization. The survey included 13 questions concerning the perceived importance of childbirth education classes, the importance of fathers attending class, the individual from whom they believed it best to learn pregnancy-related information, and structural barriers such as transportation, childcare, and the timing and cost of class participation.…”