Prenatal Group Visit Program for a Population With Limited English Proficiency

Abstract

Introduction:The declining number of family physicians providing pregnancy care is of concern because they are an important source of pregnancy care in underserved communities. Innovative approaches might reinforce family physician participation in pregnancy care for the underserved. Since group prenatal visits have been shown to improve patient education, support, and satisfaction, we implemented and evaluated a group prenatal visit program for Japanese women in Michigan, an underserved population because of their limited proficiency with English.Methods: We conducted a convergent quantitative and qualitative mixed methods evaluation involving repeated survey administration (program evaluations, 4-item Patient Health Questionnaire, pregnancy distress questionnaire) to participants during 5 group visits and in-depth postpartum interviews in the University of Michigan Japanese Family Health Program setting. We conducted independent quantitative and qualitative analytics and then thematically integrated these data.Results: Cultural adaptations to the Centering Pregnancy format involved changes in total visits, educational content, and participation format. Based on 5 groups attending 5 sessions each, 42 women evaluated the program through 158 surveys after the sessions. Participants evaluated multiple parameters positively: being with other pregnant women (98%), improving their understanding about prenatal care (96%), preparation for labor and delivery (96%), organization of visits (94%), and preparation for newborn care (85%). In final evaluations, 96% to 100% of participants rated 7 educational topics as "covered" or "covered well." Qualitative interviews with 20 women revealed positive views of social support from prenatal group visits and group facilitation but mixed enthusiasm for clinical assessments in the prenatal group visit setting and partner and children attendance at the sessions.Conclusions: This research demonstrates the feasibility and cultural acceptability of prenatal group visits for Japanese women. Prenatal group visits provided education and social support for Japanese women during the perinatal and postpartum periods that were not otherwise accessible in Japanese. This study confirms the feasibility of family physicians providing prenatal group visits and extends the literature of the applicability of prenatal group visits for patients with limited English skills. Family physicians train to provide the full breadth of care for common problems across the life span and are particularly recognized as apropos in isolated rural communities and underserved populations. As with family physicians providing care for a geographically isolated population, a bilingual family physician can also be particularly effective for linguistically and culturally isolated groups regardless of rural or urban setting.Family physicians have long been considered an important source of maternity care, particularly in rural and underserved settings. [5][6][7] The number of family physicians providing maternity care is un...

Design and Implementation of a Group Prenatal Care Model for Somali Women at a Low-Resource Health Clinic

“…Several implementation trials have occurred in resource-poor clinic settings with women from low-income and ethnic/ racial-minority backgrounds, similar to this project. GPC was shown to enhance care satisfaction for traditionally underserved women, in part through increased knowledge about care options and subsequent ability to self-advocate throughout pregnancy, labor, and the postpartum period (Cunningham et al, 2016;Little et al, 2013;Liu, Chao, Jostad-Laswell, & Duncan, 2016). We were unable to find any research in which authors examined the effectiveness of GPC adaptations in achieving these outcomes for immigrant and refugee women with unique health care needs and challenges.…”

“…We reviewed studies in which researchers examined Cen-teringPregnancy and adapted GPC models to determine methods used and benefits afforded to pregnant women, focusing on low-income and non-English-speaking populations. The CenteringPregnancy or CenteringPregnancy Plus curriculum was used in all of the primary research articles reviewed, and authors of one article on GPC presented a model adapted from CenteringPregnancy to be more culturally appropriate for a Japanese-speaking target population (Little, Motohara, Miyazaki, Arato, & Fetters, 2013).…”

“…Research on CenteringPregnancy has shown increased engagement by women in their own pregnancy care (Earnshaw et al, 2016;Heberlein et al, 2016;Tandon, Cluxton-Keller, Colon, Vega, & Alonso, 2013), increased visit attendance prenatally and postpartum (Tandon et al, 2013), and decreased maternal stress and anxiety during pregnancy (Heberlein et al, 2015;Heberlein et al, 2016;Ickovics et al, 2016;Tilden, Hersh, Emeis, Weinstein, & Caughey, 2014). More widely, research on CenteringPregnancy and GPC has shown increased knowledge of pregnancy, labor, and postpartum topics (Heberlein et al, 2016;Little, Motohara, Miyazaki, Arato, & Fetters, 2013;Tilden et al, 2014) and increased care satisfaction among women who participate in these programs compared with those who participate in individual prenatal care (Cunningham et al, 2016;Little et al, 2013;Tandon et al, 2013;Tilden et al, 2014).…”

Family Physicians Improve Patient Health Care Quality and Outcomes

“…A family medicine prenatal group visit program for a group of patients with limited English proficiency (in this case, Japanese women) is feasible, as noted by Little et al 14 Husbands and children were included and attendance and satisfaction were high.…”

Temporal Associations between Prenatal Psychosocial Context and Birth Outcomes

“…Additionally, given the positive effects of mid-pregnancy support from others found here, this study substantiates the need for continued and enhanced funding for nurse and nurse-midwifery led support interventions during pregnancy that have been shown to improve birth outcomes. These include telephone support (Bullock, Wells, Duff, & Hornblow, 1995), nurse home visiting programs (Kothari, Zielinski, James, Charoth, & Sweezy, 2013;Oakley et al, 1990;Olds et al, 1986), home visiting by paraprofessionals (Katz et al, 2011) and group prenatal care (Ickovics et al, 2003(Ickovics et al, , 2007Little, Motohara, Miyazaki, Arato, & Fetters, 2013;Tanner-Smith, Steinka-Fry, & Lipsey, 2013). The Affordable Care Act (2010) and Centers for Medicare and Medicaid Services (2012) took steps to evaluate and implement these programs, but the funding for all of them is due to run out by 2016.…”