Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care

Edmonds, Brownsyne Tucker; Mogul, Marjie; Shea, Judy A.

doi:10.1097/fch.0000000000000066

Cited by 47 publications

(100 citation statements)

References 23 publications

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“…This is consistent with previous research demonstrating higher levels of care satisfaction among women randomized to group versus individual usual care (Ickovics et al 2007) and may be the result of reduced wait times for group care visits, as well as increased social support, education, and continuity of care and personal connection with healthcare providers women value in prenatal care services (Edmonds et al 2015; Novick et al 2011). Although the number of women eligible to attend varied, average attendance rates remained consistent across sessions, indicating that once women decide to attend group sessions, they are likely to keep coming until childbirth or all sessions for their group sessions have been completed.…”

Section: Discussionsupporting

confidence: 91%

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction

Cunningham¹,

Grilo²,

Lewis³

et al. 2016

Matern Child Health J

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Introduction Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper’s objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n=547) receiving group prenatal care in New York City (2008–2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean=8.16, SD=3.08); 87% of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56% to 63%. Being born outside of the United States was significantly associated with higher group session attendance rates (B[SE]=11.46 [3.46], p=0.001), and women who received a higher proportion of care in groups reported higher levels of care satisfaction (B[SE]=0.11 [0.02], p<0.001). Discussion Future research should explore alternative implementation structures to improve pregnant women’s ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

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Section: Discussionsupporting

confidence: 91%

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction

Cunningham¹,

Grilo²,

Lewis³

et al. 2016

Matern Child Health J

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show abstract

“…Similar to the work of Tucker Edmonds et al, 2015, our findings show that there are health systems factors that negatively affect women of color's healthcare experiences. Specifically, the lack of connection participants felt to their providers, the role of trainees in their care provision and the participants' perceptions of a lack of caring or respect from their providers of care were also identified in our findings.…”

Section: Discussionsupporting

confidence: 74%

“…It is hypothesized that women of color experience longer lifetime exposure to chronic stress, which may lead to fluctuations in allostatic load (wear and tear) and contribute to the higher risk of PTB for these women (Braveman et al, 2015;Giurgescu et al, 2011). Other investigators have suggested that women of color experience discrimination, racism and disrespect in healthcare encounters and that this affects the health of women and their infants (Rankin et al, 2011;Tucker Edmonds et al, 2015;Ertel et al, 2012;Pullen et al, 2014;Nuru-Jeter et al, 2009;Dominguez et al, 2008;Slaughter-Acey et al, 2016). A recent study (SlaughterAcey et al, 2016) found significant associations between racial mircoaggressions and PTB in women who had mild to moderate, but not severe, depressive symptoms, but did not find a significant association between PTB and overall perceived stress.…”

Section: Background and Significancementioning

confidence: 99%

Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth

McLemore¹,

Altman²,

Cooper

et al. 2018

Social Science & Medicine

256

251

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Background: Chronic stress is a known risk factor for preterm birth, yet little is known about how healthcare experiences add to or mitigate perceived stress. In this study, we described the pregnancy-related healthcare experiences of 54 women of color from Fresno, Oakland, and San Francisco, California, with social and/or medical risk factors for preterm birth. Methods: This study was a secondary analysis of focus group data generated as part of a larger project focused on patient and community involvement in preterm birth research. English and Spanish speaking women, age 18 or greater with social and/or medical risk factors for preterm birth participated in two focus groups, six weeks apart. Data from the first focus groups are included in this analysis. Results: Five themes emerged from thematic analysis of the transcripts. Participants described disrespect during healthcare encounters, including experiences of racism and discrimination; stressful interactions with all levels of staff; unmet information needs; and inconsistent social support. Despite these adverse experiences, women felt confidence in parenting and newborn care. Participant recommendations for healthcare systems improvement included: greater attention to birth plans, better communication among multiple healthcare providers, more careful listening to patients during clinical encounters, increased support for social programs such as California's Black Infant Health, and less reliance on past carceral history and/or child protective services involvement. Discussion: The women in this study perceived their prenatal healthcare as a largely disrespectful and stressful experience. Our findings add to the growing literature that women of color experience discrimination, racism and disrespect in healthcare encounters and that they believe this affects their health and that of their infants.

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“…Our findings are not generalizable beyond a demographically similar populationd–by design exclusively low income, to focus on a population at known risk for disproportionately poor outcomes. It has been well-established that disparities in both accessibility and acceptability of prenatal care independently affect African American or Black women when compared with other low-income women in the United States (Bryant et al, 2010; Tucker Edmonds et al, 2015). Aspects of care such as health system trust and perceived racism, in addition to social determinants of health and differences in health status, have been implicated in these disparities (Attanasio & Kozhimannil, 2015; Gadson, Akpovi, & Mehta, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Cost, transportation, perception of low value of prenatal care by patients, and poor institutional practices have been identified as key barriers to prenatal care utilization (Mazul, Salm Ward, & Ngui, 2016; Tucker Edmonds, Mogul, & Shea, 2015). Tailoring prenatal care models to those who face disproportionate barriers and risk has been suggested as a way to adjust “undifferentiated” prenatal care delivery to further impact perinatal outcomes such as birth-weight and preterm delivery rate (Krans & Davis, 2012).…”

mentioning

confidence: 99%

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

Mehta

Carter

Vinoya

et al. 2017

Women's Health Issues

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Background Pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes, but the drivers of this association have not been explored from the patient perspective. Purpose We sought to understand maternal preference for unscheduled hospital-based obstetric care to inform interventions and improve value of publicly funded care during pregnancy. Methods We conducted a comparative qualitative analysis of in-depth semistructured interviews. Low-income pregnant women presenting to an inner city hospital-based obstetric triage unit were purposively sampled, categorized as either high or low utilizers of unscheduled care, and interviewed about challenges faced in obtaining pregnancy care and reasons for choosing between unscheduled versus scheduled care delivery. Results Demographically, high utilizers were similar to low utilizers, but were more likely to report adverse childhood experiences (p = .01). All 40 participants reported resource constraints and perceived hospital-based unscheduled obstetric care to be more accessible than outpatient prenatal care. Beyond this, high (n = 20) and low (n = 20) utilizer narratives differed significantly. Two distinct high utilizer profiles emerged. Some high utilizers repetitively used unscheduled hospital-based services owing to psychosocial determinants. Other high utilizing participants were driven by severe experiences of illness insufficiently addressed by outpatient prenatal care. Low utilizer narratives demonstrated high self-efficacy and social support compared with high utilizers. Conclusions Low-value, unscheduled, hospital-based care utilization by pregnant women of low socioeconomic status was driven by unmet clinical and psychosocial need. Implications for Policy and/or Practice Tailored community-focused innovations that use unscheduled visits as signals of risk may improve value of both outpatient and inpatient maternity care and better address adverse perinatal outcomes in vulnerable subgroups.

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Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care

Cited by 47 publications

References 23 publications

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction

Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

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