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McDonnell SM, Flynn KE, Barnekow K, Kim UO, Brazauskas R, Ahamed SI, McIntosh JJ, Pitt MB, Leuthner SR, Kruper A, Basir MA. Black Women and the Preemie Prep for Parents (P3) Program: Exploratory Analysis of a Clinical Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.28.24312637. [PMID: 39252895 PMCID: PMC11383483 DOI: 10.1101/2024.08.28.24312637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background The smartphone Preemie Prep for Parents (P3) program was developed to address the gap in prenatal education of preterm birth in high-risk pregnancies. Despite a higher incidence of preterm birth, Black women are less likely to receive prenatal education. Methods Pregnant women with medical conditions that predisposed them to preterm birth were randomized to receive the P3 program or links to American College of Obstetricians and Gynecologists webpages (control). The P3 group received periodic text messages, starting as early as 18 weeks gestational age, each with a link to a short, animated educational video. Participants completed the Parent Prematurity Knowledge Questionnaire, PROMIS Anxiety scale, and a feedback survey. This is a subgroup analysis of the Black, non-Hispanic participants in the P3 trial. Results Of the 26 Black non-Hispanic women enrolled, the P3 group (n=14) had higher knowledge scores than the control group (n=12), 67.5% correct vs. 43.6% (difference 24.0; 95% CI, 7.4 to 40.6), without experiencing an increase in anxiety. More P3 participants reported discussing preterm birth with their partner (100%) than control participants (57%; difference 43; 95% CI, 6 to 80). Conclusions The P3 program appears to be an effective method of providing preterm birth education to Black pregnant women.
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Pattath P, Maynor MR, Anson-Dwamena R. Chi-Squared Automatic Interaction Detection Decision Tree Analysis of Social Determinants for Low Birth Weight in Virginia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1060. [PMID: 39200669 PMCID: PMC11353692 DOI: 10.3390/ijerph21081060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 09/02/2024]
Abstract
This study provides additional context to the literature regarding the social inequities that impact birth outcomes in Virginia using a decision tree analysis. Chi-squared automatic interaction detection data analysis (CHAID) was performed using data from the Virginia birth registry for the years 2015-2019. Birth weight was the outcome variable, while sociodemographic factors and maternity care deserts were the explanatory variables. The prevalence of low birth weight in Virginia was of 8.1%. The CHAID decision tree model demonstrated multilevel interaction among risk factors with three levels, with a total of 34 nodes. All the variables reached significance in the model, with race/ethnicity being the first major predictor variable, each category of race and ethnicity having different significant predictors, followed by prenatal care and maternal education in the next levels. These findings signify modifiable risk factors for low birth weight, in prioritizing efforts such as programs and policies. CHAID decision tree analysis provides an effective approach to detect target populations for further intervention as pathways derived from this decision tree shed light on the different predictors of high-risk population in each of the race/ethnicity demographic categories in Virginia.
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Alameh A, Anaya F, Jabri A, Sukhon F, Alhuneafat L, Khader S, Villablanca P, Aggrawal V, Siraj A, Balakumaran K, Alqarqaz M. Hypertrophic cardiomyopathy in pregnancy: Nationwide analysis of patients characteristics and outcomes. Curr Probl Cardiol 2024; 49:102638. [PMID: 38734121 DOI: 10.1016/j.cpcardiol.2024.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) poses unique challenges in the management of pregnant patients due to the complex interplay of physiological changes of pregnancy. Despite its relatively low prevalence among pregnant women, HCM can significantly impact maternal and fetal outcomes. This study aims to enhance understanding of pregnant patients with HCM and the associated outcomes through a nationwide analysis of patient characteristics and outcomes. METHODS A retrospective analysis was conducted using data obtained from the Agency for Healthcare Research in Quality (AHRQ) Nationwide Inpatient Sample (NIS) database from January 2016 to December 2020. 3,599,855 pregnant patients without HCM and 187 pregnant patients with HCM were identified using International Classification of Disease (ICD) codes, and baseline characteristics, medical comorbidities, and outcomes were compared between the two groups. RESULTS Significant differences were observed in baseline characteristics, including age distribution, racial composition, and prevalence of systemic organ disease, between pregnant women with and without HCM. Women with HCM had higher odds of experiencing maternal complications, such as acute heart failure and peripartum cardiomyopathy, as well as higher rates of fetal distress and obstetric interventions, including preterm delivery and caesarean section. CONCLUSION Comprehensive cardiovascular assessment and risk stratification are essential in pregnant women with HCM to optimize maternal and fetal outcomes. Moreover, disparities in baseline characteristics and outcomes among black pregnant women with HCM highlight the need for a multifactorial approach to addressing pregnancy-related complications.
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Affiliation(s)
- Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Firas Anaya
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Laith Alhuneafat
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Vikas Aggrawal
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kathir Balakumaran
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mohammad Alqarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
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Harris M, Sherrod D, Walsh JL, Hunt BR, Jacobs J, Valencia J, Baumer-Mouradian S, Quinn KG. The Influence of Racism in Healthcare: COVID-19 Vaccine Hesitancy Among Black Mothers in Chicago. J Racial Ethn Health Disparities 2024; 11:2425-2434. [PMID: 37531019 DOI: 10.1007/s40615-023-01708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023]
Abstract
Black mothers and children experience significant health disparities in the USA. These health disparities have been attributed, in part, to experiencing racism in healthcare. This study aimed to explore how experiences of healthcare discrimination and mistreatment experienced by Black mothers may influence COVID-19 vaccine beliefs and decision-making for themselves and their families. From April 2021 to November 2021, we conducted 50 semi-structured interviews among Chicago residents. Ten participants self-identified as female and with reported children; these data were extracted from the larger sample for data analysis. Interview content included perceptions and experiences with the COVID-19 vaccine and experiences with healthcare discrimination, mistreatment, and medical mistrust. Interview transcripts were transcribed verbatim and coded using the MAXQDA 2022 qualitative software. Themes were identified using a team-based thematic analysis to understand how experiences of racism in healthcare may influence COVID-19 vaccine decision-making. Four themes were generated from the data: (1) experiences of healthcare discrimination and mistreatment, (2) distrust and fears of experimentation, (3) the influence of discrimination and distrust on COVID-19 vaccine decision-making, and (4) overcoming vaccine hesitancy. The results of this study highlight the current literature; Black mothers experience racism and discrimination in healthcare when seeking care for themselves and their children. It is evident in their stories that medical racism and historical medical abuse influence vaccine decision-making. Therefore, healthcare and public health initiatives should be intentional in addressing past and present racism in healthcare to improve vaccine distrust.
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Affiliation(s)
- Melissa Harris
- Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Darielle Sherrod
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bijou R Hunt
- Sinai Health System, Sinai Infectious Disease Center, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jesus Valencia
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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Nijagal MA, Odiase OJ, Bell AJ, El Ayadi AM, Williams S, Nicolaisen C, Jacobs G, Mack B, LaSerre M, Stewart C, Crockett K, Afulani PA. The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco. Birth 2024. [PMID: 38887141 DOI: 10.1111/birt.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/22/2024] [Accepted: 05/02/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. METHODS Community engagement (PRECEDE phases 1-2) informed the "Pregnancy Village" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring "one-stop-shop" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys. RESULTS The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement. CONCLUSION Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.
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Affiliation(s)
- Malini A Nijagal
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - April J Bell
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Schyneida Williams
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Chloe Nicolaisen
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, USA
| | - Garrett Jacobs
- Designing Justice + Designing Spaces (DJDS), Oakland, California, USA
| | - Brandi Mack
- Designing Justice + Designing Spaces (DJDS), Oakland, California, USA
| | - Monique LaSerre
- Rafiki Coalition for Health and Wellness, San Francisco, California, USA
| | - Chelsea Stewart
- Rafiki Coalition for Health and Wellness, San Francisco, California, USA
| | | | - Patience A Afulani
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
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Stibbards-Lyle M, Malinovska J, Badawy S, Schedin P, Rinker KD. Status of breast cancer detection in young women and potential of liquid biopsy. Front Oncol 2024; 14:1398196. [PMID: 38835377 PMCID: PMC11148378 DOI: 10.3389/fonc.2024.1398196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/06/2024] Open
Abstract
Young onset breast cancer (YOBC) is an increasing demographic with unique biology, limited screening, and poor outcomes. Further, women with postpartum breast cancers (PPBCs), cancers occurring up to 10 years after childbirth, have worse outcomes than other young breast cancer patients matched for tumor stage and subtype. Early-stage detection of YOBC is critical for improving outcomes. However, most young women (under 45) do not meet current age guidelines for routine mammographic screening and are thus an underserved population. Other challenges to early detection in this population include reduced performance of standard of care mammography and reduced awareness. Women often face significant barriers in accessing health care during the postpartum period and disadvantaged communities face compounding barriers due to systemic health care inequities. Blood tests and liquid biopsies targeting early detection may provide an attractive option to help address these challenges. Test development in this area includes understanding of the unique biology involved in YOBC and in particular PPBCs that tend to be more aggressive and deadly. In this review, we will present the status of breast cancer screening and detection in young women, provide a summary of some unique biological features of YOBC, and discuss the potential for blood tests and liquid biopsy platforms to address current shortcomings in timely, equitable detection.
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Affiliation(s)
- Maya Stibbards-Lyle
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Cellular and Molecular Bioengineering Research Lab, University of Calgary, Calgary, AB, Canada
| | - Julia Malinovska
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Cellular and Molecular Bioengineering Research Lab, University of Calgary, Calgary, AB, Canada
| | - Seleem Badawy
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Cellular and Molecular Bioengineering Research Lab, University of Calgary, Calgary, AB, Canada
| | - Pepper Schedin
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, United States
| | - Kristina D Rinker
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Cellular and Molecular Bioengineering Research Lab, University of Calgary, Calgary, AB, Canada
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
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Ware KS, Lee ASD, Rodriguez M, Williams CH. Perceptions to Overcoming Barriers to Prenatal Care in African American Women. Nurs Clin North Am 2024; 59:121-129. [PMID: 38272578 DOI: 10.1016/j.cnur.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Pregnancy-related deaths affect African American women at a rate four to five times higher than White women. These deaths occur during pregnancy or up to 1 year after childbirth. Inadequate or delayed prenatal care is a factor associated with poor maternal health outcomes in African American women. Identifying factors that pose as facilitators and barriers to prenatal care is essential in developing interventions aimed at improving maternal health outcomes.
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Affiliation(s)
- Katilya S Ware
- Auburn University College of Nursing, 710 South Donahue Drive, Auburn, AL 36849, USA.
| | - Amy S D Lee
- Capstone College of Nursing 3006, Box 870358, Tuscaloosa, AL 35487, USA
| | - Mayra Rodriguez
- Edward Via College of Osteopathic Medicine Auburn, 910 South Donahue Drive, Auburn, AL 36832, USA
| | - Courtney H Williams
- Auburn University College of Nursing, 710 South Donahue Drive, Auburn, AL 36832, USA
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Zaganjor I, Kramer RD, Kofie JN, Sawdey MD, Cullen KA. Trends in Smoking Before, During, and After Pregnancy in the United States from 2000 to 2020: Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2024; 33:283-293. [PMID: 38153374 DOI: 10.1089/jwh.2023.0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objectives: This study used 2000-2020 Pregnancy Risk Assessment Monitoring System data to estimate trends in smoking before, during, and after pregnancy, as well as quitting smoking during pregnancy. Materials and Methods: Weighted prevalence and 95% confidence intervals (CIs) were calculated by year for each smoking-related measure. Annual percent change (APC) and average annual percent change (AAPC) in prevalence were estimated using Joinpoint regression to characterize trends over time. Results: Between 2000 and 2020, significant decreases in the prevalence of smoking before (23.0% to 14.0%; AAPC = -2.3% [95% CI = -2.9% to -1.7%]), during (13.2% to 6.5%; AAPC = -3.4% [95% CI = -4.0% to -2.7%]), and after pregnancy (18.9% to 8.8%; AAPC = -3.6% [95% CI = -4.3% to -2.9%]) were observed. For each measure, the fastest declines occurred largely throughout the 2010s (before: APC = -5.5% [2012-2020]; during: APC = -5.1% [2009-2020]; and after: APC = -6.4% [2012-2020]). The proportion of people who quit smoking during pregnancy significantly increased from 43.2% in 2000 to 53.7% in 2020 (AAPC = 1.0%; 95% CI = 0.2%-1.9%); however, Joinpoint regression detected relatively no change in quitting during pregnancy between 2010 and 2020 (APC = 0.0%; 95% CI = -0.4% to 0.5%). Conclusions: The prevalence of smoking before, during, and after pregnancy has reduced dramatically in the United States between 2000 and 2020, with the fastest declines occurring throughout the second decade of the twenty-first century. However, prevention and cessation efforts are still needed since approximately half of people who smoked before pregnancy continue to smoke during pregnancy.
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Affiliation(s)
- Ibrahim Zaganjor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Renee D Kramer
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justina N Kofie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael D Sawdey
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Karen A Cullen
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Holicky A, Anderson-Reeves T, Bennett AC, Lightner S, McRae KD, Handler A. Child Care as a Barrier to Perinatal Health Care in Illinois. Matern Child Health J 2024; 28:221-228. [PMID: 37831338 PMCID: PMC10922574 DOI: 10.1007/s10995-023-03784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017-2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care DESCRIPTION: TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60). ASSESSMENT Each group reported that child care concerns negatively affect health care utilization (66% of birthing hospitals, 50% of FQHCs, and 32% of postpartum persons). Among postpartum persons, the most common reported reason for missing a visit due to child care issues was "not feeling comfortable leaving my child(ren) in the care of others" (22%). The most common child care resource reported by facilities was "staff watching children" (53% of birthing hospitals, 75% of FQHCs); however, most did not have formal child care policies or dedicated space for children. Fewer than half of FQHCs (43%) discussed child care at the first prenatal visit. CONCLUSION The project prompted the Illinois Title V program to add a child care-related strategy to their 2021-2025 Action Plan, providing opportunity for further examination of practices and policies that could be implemented to reduce child care barriers to perinatal care. Systematically addressing child care in health care settings may improve health care utilization among birthing/postpartum persons.
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Affiliation(s)
- Abigail Holicky
- Department of Medicine, Division of Academic Internal Medicine, Westside Research Office Building, University of Illinois at Chicago, 1747 W. Roosevelt Road, Room 274, Chicago, IL, 60612, USA.
- Illinois Department of Public Health (Formerly), Illinois, USA.
| | | | - Amanda C Bennett
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Field Support Branch, Maternal and Child Health Epidemiology Program, Atlanta, USA
- Illinois Department of Public Health, Office of Women's Health and Family Services, Title V Program, Illinois, USA
| | - Shannon Lightner
- Illinois Department of Public Health, Office of Women's Health and Family Services, Title V Program, Illinois, USA
| | - Kenya D McRae
- Illinois Department of Public Health (Formerly), Illinois, USA
| | - Arden Handler
- School of Public Health, University of Illinois at Chicago, Chicago, USA
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McGaughey P, Howland RE, Dragan KL. Variation in Preterm Birth Rates Across Prenatal Care Sites in New York. J Obstet Gynecol Neonatal Nurs 2024; 53:46-56. [PMID: 37951580 DOI: 10.1016/j.jogn.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE To investigate variation in preterm birth rates by the site at which prenatal care was received. DESIGN Cross-sectional cohort study. SETTING New York State. PARTICIPANTS Claims and encounter data on singleton live births that were covered by New York Medicaid (N = 154,377). METHODS We analyzed data from New York Medicaid and the American Community Survey. We established sites of prenatal care using geocoded billing addresses for prenatal visits. We calculated descriptive statistics and conducted logistic regression analyses to determine variation in crude and risk-adjusted preterm birth rates by prenatal care site. RESULTS The crude preterm birth rates averaged 7.8% (range = 2.0%-18.7%) by prenatal care site. The adjusted preterm birth rate was 8.0% (range = 2.8%-18.5%) by prenatal care site. Risk-adjusted preterm birth site-level rates at the 90th percentile were 2.7 times higher than those in the 10th percentile. The variation in risk-adjusted preterm birth site-level rates was not fully explained by birth volume, rural site location, or racial and ethnic composition of the patients who received prenatal care at the site. CONCLUSION Wide variation in risk-adjusted preterm birth rates across prenatal care sites exists, and factors beyond known individual demographics and medical factors contribute to the variation. Further research is warranted to identify why receiving care at some prenatal sites is associated with higher risk of preterm birth than receiving care at others.
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Warzywoda S, Fowler JA, Nourse C, Wu M, Britton S, Rowling D, Griffin P, Lazarou M, Hamilton Z, Dean JA. Syphilis in pregnancy: a qualitative investigation of healthcare provider perspectives on barriers to syphilis screening during pregnancy in south-east Queensland. Sex Health 2023; 20:330-338. [PMID: 37245957 DOI: 10.1071/sh22193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Increasing rates of syphilis in pregnancy (SiP) in Australia and other high-income countries, has led to the resurgence of congenital syphilis. Suboptimal syphilis screening during pregnancy has been identified as a key contributing factor. METHODS This study aimed to explore, from the perspective of multidisciplinary healthcare providers (HCPs), the barriers to optimal screening during the antenatal care (ANC) pathway. Semi-structured interviews conducted with 34 HCPs across multiple disciplines practising in south-east Queensland (SEQ) were analysed through a process of reflexive thematic analysis. RESULTS Barriers were found to occur at the system level of ANC, through difficulties in patient engagement in care, limitations in the current model of health care delivery and limitations in the communication pathways across health care disciplines; and at the individual HCP level, through HCP knowledge and awareness of epidemiological changes in syphilis in SEQ, and adequately assessing patient risk. CONCLUSION It is imperative that the healthcare systems and HCPs involved in ANC address these barriers to improve screening in order to optimise management of women and prevent congenital syphilis cases in SEQ.
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Affiliation(s)
- Sarah Warzywoda
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld 4006, Australia
| | - James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld 4006, Australia
| | - Clare Nourse
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Infection Management and Prevention Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Mandy Wu
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Sumudu Britton
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, 7 Butterfield Street, Herston, Qld 4029, Australia
| | - Diane Rowling
- Metro North Public Health Unit, Metro North Hospital and Health Service, Bryden Street, Windsor, Qld 4030, Australia
| | - Paul Griffin
- The University of Queensland, Faculty of Medicine, School of Medicine, 288 Herston Road, Herston, Qld 4006, Australia; and Mater Health Brisbane, Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Mattea Lazarou
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld 4006, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Qld 4101, Australia
| | - Zoe Hamilton
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld 4006, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, 288 Herston Road, Herston, Qld 4006, Australia
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Adams V, Craddock J. Patient-provider communication quality as a predictor of medical mistrust among young Black women. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:334-343. [PMID: 36762615 PMCID: PMC10120919 DOI: 10.1080/19371918.2023.2177225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The present study explores the association between patient-provider communication quality and medical mistrust in a sample of 174 young Black women, aged 18-24. Data were collected as part of a larger mixed-methods study examining sexual health communication and behaviors. Participants were recruited via non-probabilistic sampling methods between June 2018 and December 2018. Eligible respondents completed a self-administered online study that examined, among other components, healthcare experiences and medical mistrust. Hierarchical linear regression was used to explore the relationship between patient-provider communication quality and medical mistrust. Patient-provider communication quality was a significant predictor of medical mistrust; as communication quality increased, medical mistrust decreased (p < .001). Educational attainment also emerged as a significant predictor. Relative to not completing any college, completing some college was associated with lower medical mistrust (p= .031). Our findings suggest that for providers seeking to address medical mistrust in patients identifying as young Black women, focusing on patient-centered communication may be particularly impactful.
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Affiliation(s)
- Vashti Adams
- School of Social Work, University of Maryland, Baltimore, Maryland, USA
| | - Jaih Craddock
- School of Medicine, University of California Irvine, Irvine, California, USA
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Renbarger KM, Phelps B, Broadstreet A. Provider Characteristics That Hinder Relationships with Black Women in the Perinatal Period. West J Nurs Res 2023; 45:215-225. [PMID: 36016493 DOI: 10.1177/01939459221120390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Black women have often reported challenges in their relationships with health care providers during the perinatal period. This study synthesized the findings of qualitative studies to describe health care providers' characteristics that hinder therapeutic relationships with Black women in the perinatal period. A systematic search was conducted and findings from 12 qualitative studies were synthesized using a thematic synthesis approach. Two overarching themes that included seven descriptive themes were discovered. The seven descriptive themes include the following: (1) provides differential treatment; (2) expresses biased attitudes; (3) lacks empathy; (4) limits choices; (5) communicates inadequate health information; (6) provides deficient care; and (7) dismisses concerns. Participants experienced challenged relationships with health care providers who held implicit biases and discouraged them from participating in their care. The findings suggest the importance of confronting implicit biases, promoting a bias-free health care system, and providing quality care that is respectful to Black women in the perinatal period.
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Collins C, Bai R, Brown P, Bronson CL, Farmer C. Black women's experiences with professional accompaniment at prenatal appointments. ETHNICITY & HEALTH 2023; 28:61-77. [PMID: 35067127 DOI: 10.1080/13557858.2022.2027880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
U.S. public health statistics report dismal Black infant and maternal mortality rates. Prenatal care alone, while essential, does not reduce such disparities. OBJECTIVES The purpose of the study was to explore Black women's experiences when a perinatal support professional (PSP) accompanies them to prenatal medical appointments. DESIGN This research used a phenomenological approach, using data from in-depth individual interviews to explore the essence of 25 Black women's experiences. RESULTS We identified three major themes from the data that together, show that PSPs served as communication bridges for their clients. Clients said their PSPs helped them to understand and feel seen and heard by their medical providers during their prenatal appointments. The third theme was the deep level of trust the clients developed for their PSPs which made the first two themes possible. PSPs' intervention resulted in reduced stress and uncertainty in medical interactions and increased women's trust in their providers' recommendations. CONCLUSIONS Including a trusted, knowledgeable advocate like a PSP may be an important intervention in improving Black women's prenatal care experiences, reducing stress associated with medical interactions, and ultimately reducing pregnancy-related health disparities.
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Affiliation(s)
- Cyleste Collins
- Cleveland State University, School of Social Work, Cleveland, OH, USA
| | - Rong Bai
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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Murphy L, Liu F, Keele R, Spencer B, Kistner Ellis K, Sumpter D. An Integrative Review of the Perinatal Experiences of Black Women. Nurs Womens Health 2022; 26:462-472. [PMID: 36328085 DOI: 10.1016/j.nwh.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/10/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To synthesize the current body of evidence regarding the perinatal experiences of Black women. DATA SOURCES The databases PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus were searched with the search terms "African American" (in PubMed), "Black" (in Scopus), or "Black" OR "African American" (in CINAHL) AND "pregnancy" AND "experiences." STUDY SELECTION Searches yielded 266 articles published between January 2015 and May 2021. After initial screening, 68 articles were assessed for eligibility, yielding 23 studies that met the inclusion criteria of this review. DATA EXTRACTION Studies were reviewed for the perinatal experiences of Black women. Nonresearch articles, systematic reviews, and instrument development articles were removed. Also excluded were articles with a focus on adolescent pregnancy, breastfeeding experiences, and those outside of the perinatal time frame. DATA SYNTHESIS Analysis showed that Black women continue to report negative experiences in perinatal care and that these negative experiences spanned various sociodemographic characteristics. Although some Black women described positive interactions, many more expressed dissatisfaction with the lack of education, resources, and continuity in care, as well as poor communication. Additionally, experiences of racism and biases in care, mistrust in the health care system, and doubts of the efficacy or necessity of medical treatments exist. CONCLUSION Negative perinatal care experiences and dissatisfaction among Black women remain common. Although Black women desire more holistic, naturalistic, and empowering care, Black women first want safe, respectful care and a health care team that removes biases and racism from its system. More research is needed that includes the voices of Black women to understand these experiences and to develop interventions to improve the perinatal care experience. Nurses and other health care providers providing care in the perinatal period must also listen to, trust, and respect Black women.
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Peahl AF, Moniz MH, Heisler M, Doshi A, Daniels G, Caldwell M, Dalton VK, De Roo A, Byrnes M. Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study. JAMA Netw Open 2022; 5:e2238161. [PMID: 36279136 PMCID: PMC9593232 DOI: 10.1001/jamanetworkopen.2022.38161] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. OBJECTIVE To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. DESIGN, SETTING, AND PARTICIPANTS For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user's perspective) and ideation (generating novel potential solutions). Questions targeted participants' experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. MAIN OUTCOMES AND MEASURES Preferences for prenatal care redesign. RESULTS Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. CONCLUSIONS AND RELEVANCE In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients' needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients' social needs and preferences.
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Affiliation(s)
- Alex Friedman Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor
| | - Michelle H. Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor
| | - Michele Heisler
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Aalap Doshi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor
| | | | - Martina Caldwell
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Program on Women’s Healthcare Effectiveness Research, University of Michigan, Ann Arbor
| | - Ana De Roo
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Mary Byrnes
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
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Parlier-Ahmad AB, Keyser-Marcus L, Bishop D, Jones H, Svikis DS. Improving Peripartum Care Engagement Among Black Women at Risk for Low Prenatal Care Attendance: A Secondary Analysis of Predictors of Attendance and Sample Representativeness. J Womens Health (Larchmt) 2022; 31:1490-1500. [PMID: 35352968 DOI: 10.1089/jwh.2021.0197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The United States has unacceptably high rates of maternal and infant mortality, especially among Black women and their infants. Prenatal and postpartum care help reduce maternal and infant morbidity and mortality; however, Black women are less likely to access and utilize peripartum care largely due to structural racism. Identifying factors that buffer against the systemic barriers disproportionately impacting this community is an important step in addressing racial health disparities. Using existing data from a randomized controlled trial (RCT) targeting maternal and infant health disparities, this study aims to (1) explore predictors of peripartum care attendance and (2) examine clinical trial sample representativeness. Methods: The analyses addressing the primary aim of the study included Black women at risk for low prenatal care (PNC) engagement who consented to RCT participation and had a documented live birth (n = 123). For the secondary study aim, comparisons between women who consented to the RCT (Consenters; n = 149) and those who did not (Non-consenters; n = 122) were made using chi-square and t-tests. Results: Hierarchical linear and logistic regression identified predictors of prenatal and postpartum care attendance, respectively. After controlling for multiple comparisons, no significant differences were identified between characteristics of Consenters and Non-consenters. Older age (p = 0.038), high-risk pregnancy (p < 0.001), and no past week substance use (p = 0.033) predicted better PNC attendance. PNC attendance predicted postpartum visit attendance (p < 0.001). Conclusions: This study provides benchmark data on predictors of peripartum care and sample representativeness in RCTs. Findings have important implications for health care system changes and development of culturally informed interventions.
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
- Institute for Women's Health, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lori Keyser-Marcus
- Department of Psychiatry, and Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Diane Bishop
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Heather Jones
- Department of Psychology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace S Svikis
- Department of Psychology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
- Institute for Women's Health, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Puthussery S, Tseng PC, Sharma E, Harden A, Griffiths M, Bamfo J, Li L. Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation. BMC Pregnancy Childbirth 2022; 22:713. [PMID: 36123628 PMCID: PMC9484064 DOI: 10.1186/s12884-022-04984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. METHODS A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007-March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13-19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. RESULTS Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. CONCLUSIONS There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK.
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square, EC1V 0HB, London, England
| | - Malcolm Griffiths
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Jacqueline Bamfo
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Adebayo CT, Parcell ES, Mkandawire-Valhmu L, Olukotun O. African American Women's Maternal Healthcare Experiences: A Critical Race Theory Perspective. HEALTH COMMUNICATION 2022; 37:1135-1146. [PMID: 33601991 DOI: 10.1080/10410236.2021.1888453] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black women are experiencing pregnancy-related complications at a significantly higher rate than women of other races in the U.S., as Black women are three to four times likely to die from pregnancy-related complications compared to non-Hispanic White women. Structural barriers and different forms of marginalization continue to limit Black women's access to quality healthcare services. Through critical race theory, we examine what structural barriers exist in the U.S. healthcare system, one that limits access to quality care during their prenatal and postnatal doctor's visits. Using qualitative in-depth interviews, 31 African American women, living in Milwaukee, WI, shared their pregnancy stories. The emergent themes include, institutionalized care - racially insensitive biomedical approach, race and class - unfair treatment based on health insurance, and race as a social concept - dismissed pain concerns because you are a strong Black woman. These themes reveal the experience of racial discrimination toward African American women through healthcare [communicative] practices that are often times seen as "standard" practices, albeit marginalizing minority populations. Findings from this study offer insights for healthcare providers on communicative practices that foster a racially-safe healthcare environment for African American women.
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Bellerose M, Rodriguez M, Vivier PM. A systematic review of the qualitative literature on barriers to high-quality prenatal and postpartum care among low-income women. Health Serv Res 2022; 57:775-785. [PMID: 35584267 PMCID: PMC9264457 DOI: 10.1111/1475-6773.14008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the qualitative literature on low-income women's perspectives on the barriers to high quality prenatal and postpartum care. DATA SOURCES AND STUDY SETTING We performed searches in PubMed, Web of Science, Embase, SocIndex, and CINAHL for peer-reviewed studies published between 1990 to 2021. STUDY DESIGN Systematic review of qualitative studies with participants who were currently pregnant or had delivered within the past two years and identified as low-income at delivery. DATA COLLECTION / EXTRACTION METHODS Two reviewers independently assessed studies for inclusion, evaluated study quality, and extracted information on study design and themes. PRINCIPLE FINDINGS We identified 34 studies that met inclusion criteria, including 23 focused on prenatal care, 6 on postpartum care, and 5 on both. The most frequently mentioned barriers to prenatal and postpartum care were structural. These included delays in gaining pregnancy-related Medicaid coverage, challenges finding providers who would accept Medicaid, lack of provider continuity, transportation and childcare hurdles, and legal system concerns. Individual-level factors, such as lack of awareness of pregnancy, denial of pregnancy, limited support, conflicting priorities, and indifference to pregnancy also interfered with timely use of prenatal and postpartum care. For those who accessed care, experiences of dismissal, discrimination, and disrespect related to race, insurance status, age, substance use, and language were common. CONCLUSIONS Over a period of 30 years, qualitative studies have identified consistent structural and individual barriers to high-quality prenatal and postpartum care. Medicaid policy changes including expanding presumptive eligibility, increased reimbursement rates for pregnancy services, payment for birth doula support, and extension of postpartum coverage may help overcome these challenges.
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Affiliation(s)
- Meghan Bellerose
- Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI
| | - Mariela Rodriguez
- Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI
| | - Patrick M Vivier
- Health Services, Policy, and Practice, Brown University School of Public Health, Pediatrics and Emergency Medicine, Warren Alpert Medical School, 121 South Main Street, Providence, RI
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21
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Jahn JL, Simes JT. Prenatal healthcare after sentencing reform: heterogeneous effects for prenatal healthcare access and equity. BMC Public Health 2022; 22:954. [PMID: 35549928 PMCID: PMC9102339 DOI: 10.1186/s12889-022-13359-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background High rates of imprisonment in the U.S. have significant health, social, and economic consequences, particularly for marginalized communities. This study examines imprisonment as a contextual driver of receiving prenatal care by evaluating whether early and adequate prenatal care improved after Pennsylvania’s criminal sentencing reform reduced prison admissions. Methods We linked individual-level birth certificate microdata on births (n = 999,503) in Pennsylvania (2009–2015), to monthly county-level rates of prison admissions. We apply an interrupted time series approach that contrasts post-policy changes in early and adequate prenatal care across counties where prison admissions were effectively reduced or continued to rise. We then tested whether prenatal care improvements were stronger among Black birthing people and those with lower levels of educational attainment. Results In counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). We find this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment. Conclusions Pennsylvania’s sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13359-7.
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Affiliation(s)
- Jaquelyn L Jahn
- The Ubuntu Center On Racism, Global Movements and Population Health Equity, Drexel University Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA.
| | - Jessica T Simes
- Department of Sociology, Boston University, 100 Cummington Mall, Boston, MA, 02215, USA
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22
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Schwartz N, Mhajna M, Moody HL, Zahar Y, Shkolnik K, Reches A, Lowery CL. Novel uterine contraction monitoring to enable remote, self-administered nonstress testing. Am J Obstet Gynecol 2022; 226:554.e1-554.e12. [PMID: 34762863 DOI: 10.1016/j.ajog.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serial fetal monitoring recommended for women with high-risk pregnancies places a substantial burden on the patient, often disproportionately affecting underprivileged and rural populations. A telehealth solution that can empower pregnant women to obtain recommended fetal surveillance from the comfort of their own home has the potential to promote health equity and improve outcomes. We have previously validated a novel, wireless pregnancy monitor that can remotely capture fetal and maternal heart rates. However, such a device must also detect uterine contractions if it is to be used to robustly conduct remote nonstress tests. OBJECTIVE This study aimed to describe and validate a novel algorithm that uses biopotential and acoustic signals to noninvasively detect uterine contractions via a wireless pregnancy monitor. STUDY DESIGN A prospective, open-label, 2-center study evaluated simultaneous detection of uterine contractions by the wireless pregnancy monitor and an intrauterine pressure catheter in women carrying singleton pregnancies at ≥32 0/7 weeks' gestation who were in the first stage of labor (ClinicalTrials.gov Identifier: NCT03889405). The study consisted of a training phase and a validation phase. Simultaneous recordings from each device were passively acquired for 30 to 60 minutes. In a subset of the monitoring sessions in the validation phase, tocodynamometry was also deployed. Three maternal-fetal medicine specialists, blinded to the data source, identified and marked contractions in all modalities. The positive agreement and false-positive rates of both the wireless monitor and tocodynamometry were calculated and compared with that of the intrauterine pressure catheter. RESULTS A total of 118 participants were included, 40 in the training phase and 78 in the validation phase (of which 39 of 78 participants were monitored simultaneously by all 3 devices) at a mean gestational age of 38.6 weeks. In the training phase, the positive agreement for the wireless monitor was 88.4% (1440 of 1692 contractions), with a false-positive rate of 15.3% (260/1700). In the validation phase, using the refined and finalized algorithm, the positive agreement for the wireless pregnancy monitor was 84.8% (2722/3210), with a false-positive rate of 24.8% (897/3619). For the subgroup who were monitored only with the wireless monitor and intrauterine pressure catheter, the positive agreement was 89.0% (1191/1338), with a similar false-positive rate of 25.4% (406/1597). For the subgroup monitored by all 3 devices, the positive agreement for the wireless monitor was significantly better than for tocodynamometry (P<.0001), whereas the false-positive rate was significantly higher (P<.0001). Unlike tocodynamometry, whose positive agreement was significantly reduced in the group with obesity compared with the group with normal weight (P=.024), the positive agreement of the wireless monitor did not vary across the body mass index groups. CONCLUSION This novel method to noninvasively monitor uterine activity, via a wireless pregnancy monitoring device designed for self-administration at home, was more accurate than the commonly used tocodynamometry and unaffected by body mass index. Together with the previously reported remote fetal heart rate monitoring capabilities, this added ability to detect uterine contractions has created a complete telehealth solution for remote administration of nonstress tests.
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23
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Sebens Z, Williams AD. Disparities in early prenatal care and barriers to access among American Indian and white women in North Dakota. J Rural Health 2022; 38:314-322. [PMID: 35165911 DOI: 10.1111/jrh.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE American Indians/Alaska Natives (AI/AN) have received minimal attention in research on determinants of prenatal care access. We sought to gain an understanding of structural and sociocultural determinants of prenatal care access among AI/AN and White women in North Dakota (ND). METHODS Data were drawn from the 2017 to 2018 North Dakota Pregnancy Risk Assessment Monitoring System (n = 1,166). Late prenatal care was assessed with 2 variables: late prenatal care initiation (>13 weeks gestation) and "Did you get prenatal care as early in your pregnancy as you wanted?" (yes/no). Those not satisfied with timing of prenatal care initiation reported 12 prenatal care barriers (yes/no). Logistic regression estimated odds ratios and 95% confidence internals for late prenatal care among AI/AN and other race/ethnicity women compared to White women. Models included maternal sociodemographic, medical, and behavior factors. Chi-square was used to examine the prevalence of prenatal care barriers by race/ethnicity. FINDINGS AI/AN women had increased risk of late prenatal care initiation (OR: 1.93, 95%CI: 1.20, 3.09) and were more dissatisfied with timing of prenatal care initiation (OR: 1.73, 95% CI: 1.07, 2.78) compared to White women. AI/AN women reported higher prevalence for 8 of 12 (66%) barriers to care, including lack of transportation. Lack of health insurance was more prevalent among White women than AI/AN women (45%-8.5%; P<.01). CONCLUSIONS Socioeconomic barriers to prenatal care are more prevalent among AI/AN women. This may be a consequence of systematic separation of AI/AN populations from health care resources. Alternative prenatal care delivery methods and expansion of health insurance may improve prenatal care access in ND.
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Affiliation(s)
- Zachary Sebens
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Andrew D Williams
- Public Health Program, Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
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Dailey RK, Peoples A, Zhang L, Dove‐Medows E, Price M, Misra DP, Giurgescu C. Assessing Perception of Prenatal Care Quality Among Black Women in the United States. J Midwifery Womens Health 2022; 67:235-243. [PMID: 35060657 PMCID: PMC10181860 DOI: 10.1111/jmwh.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There has been little attention to measuring quality of prenatal care from a Black person's perspective. We examined validity and reliability of the Quality of Prenatal Care Questionnaire (QPCQ) and perceptions of the quality of prenatal care among pregnant Black women. METHODS A total of 190 women had complete data on the postpartum questionnaire containing the QPCQ within 8 weeks after birth. Internal consistency reliability was assessed using Cronbach's α. Construct validity was assessed through hypothesis testing using select questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) and Pearson's r correlation. RESULTS The mean (SD) maternal age was 26.5 (5.5) years, and 85.3% of births were term (>37 weeks' 0 days' gestation). The total mean (SD) QPCQ score was 191.3 (27.9) points (range 46-230), and the mean (SD) item score for the subscales ranged from 3.88 (0.80) points to 4.27 (0.64). The Cronbach's α for the overall QPCQ score was .97 and ranged from .72 to .96 for the 6 subscale scores, which indicated acceptable internal consistency reliability. All but one subscale had a Cronbach's α higher than .80. The Approachability subscale had a Cronbach's α of .72. Construct validity demonstrated a moderate and significant positive correlation between the PRAMS items and the QPCQ (r = .273, P < .001). DISCUSSION To our knowledge, this is the first study to examine the validity and reliability of the QPCQ and perceptions of quality of prenatal care among Black women from the United States. The results indicate that participants rate the quality of their prenatal care highly and that the QPCQ is a reliable and valid measure of the quality of prenatal care. Use of a convenient and reliable instrument to measure the quality of prenatal care rather than prenatal care satisfaction or utilization may help to elucidate the factors of prenatal care that are protective specifically among Black women.
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Affiliation(s)
- Rhonda K. Dailey
- Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit Michigan
| | - Ashleigh Peoples
- Department of Family Medicine University of Pittsburgh Medical Center Shadyside Pittsburgh Pennsylvania
| | - Liying Zhang
- Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit Michigan
| | | | - Mercedes Price
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine East Lansing Michigan
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics Michigan State University College of Human Medicine East Lansing Michigan
| | - Carmen Giurgescu
- College of Nursing University of Central Florida Orlando Florida
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Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
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Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
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Patterson JA, Keuler NS, Buckingham WR. Differences in Exclusive Breastfeeding Rates in US Hospitals According to Baby-Friendly Hospital Initiative Designation and Area Deprivation Index Category. Breastfeed Med 2021; 16:799-806. [PMID: 34107777 DOI: 10.1089/bfm.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Disparities in breastfeeding persist placing a greater burden of disease on non-Hispanic black and Hispanic women and infants. Targeted implementation of the Baby-Friendly Hospital Initiative (BFHI) in areas at risk for poor breastfeeding outcomes has been shown to improve disparities in breastfeeding. The area deprivation index (ADI), a measure of the relative socioeconomic disadvantage of a neighborhood, may be useful in exploring the accessibility of BFHI hospitals in highly deprived areas and the differences in exclusive breastfeeding (EBF) rates in hospitals with and without the BFHI designation across deprivation categories. Objective: To evaluate the geographical distribution of BFHI and non-BFHI hospitals across ADI categories and explore the differences in EBF rates in BFHI and non-BFHI hospitals across ADI categories. Methods: Hospital EBF rates obtained from the Joint Commission included 414 BFHI and 1,532 non-BFHI hospitals. State ADI rank scores were determined for each hospital's census block group. Descriptive statistics were used to describe the geographic distribution of BFHI hospitals across three ADI categories (low, medium, and high). EBF rates across ADI categories and BFHI designations were compared using multiway analysis of variance. Results: The distribution of BFHI was similar across all ADI categories, ranging from 18% to 24%. EBF rates were 4.9% lower in highly deprived areas compared to areas with lower deprivation (p < 0.01). BFHI was associated with significantly higher EBF rates across all ADI categories (6.9%-11.2%, p < 0.01). Conclusion: ADI may be a useful tool for targeting the implementation of BFHI in hospitals in highly deprived areas to reduce breastfeeding disparities.
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Affiliation(s)
- Julie A Patterson
- School of Health Studies, College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Nicholas S Keuler
- Department of Statistics, College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - William R Buckingham
- Department of Medicine, Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Fisher SA, Sakowicz A, Barnard C, Kidder S, Miller ES. Neighborhood deprivation and preterm delivery during the coronavirus 2019 pandemic. Am J Obstet Gynecol MFM 2021; 4:100493. [PMID: 34562637 PMCID: PMC8457630 DOI: 10.1016/j.ajogmf.2021.100493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prior studies have reported decreases in the preterm delivery incidence during the COVID-19 pandemic. However, the findings are inconsistent. Given the wide disparities in the pandemic's impact across communities, neighborhood deprivation may explain the observed variation in the relationship between the COVID-19 pandemic and preterm delivery. OBJECTIVE To characterize the changes in the incidence of preterm delivery during the COVID-19 pandemic with attention to the effect modification introduced by neighborhood hardship. STUDY DESIGN This retrospective cohort study included all the pregnant patients who delivered at an urban tertiary care hospital during the pandemic (April–November 2020) or before the pandemic (April–November 2019). We compared the incidence of preterm delivery, spontaneous preterm delivery, and medically indicated preterm delivery before 37 weeks’ gestation across epochs. Planned analyses stratified the cohorts by neighborhood deprivation metrics defined by the residential zip code; the metrics included the median neighborhood household income and the hardship index (a composite index including dependency, educational attainment, unemployment, poverty, per capita income, and crowded housing). The Breslow-Day test for homogeneity assessed the association of the delivery epoch and neighborhood deprivation with the preterm delivery outcomes. RESULTS Of 16,544 eligible deliveries, 8.7% occurred preterm. The incidences of preterm delivery (8.4% vs 9.0%; P=.17), spontaneous preterm delivery (5.0 vs 5.4%; P=.27), and medically indicated preterm delivery (3.2% vs 3.5%; P=.47) were similar in the pandemic and prepandemic epochs. However, the preterm delivery (odds ratio, 0.78; 95% confidence interval, 0.64–0.96) and spontaneous preterm delivery (odds ratio, 0.76; 95% confidence interval, 0.59–0.99) decreased from the prepandemic to the pandemic epoch in those living in neighborhoods <50th percentile for median income (Breslow-Day P values.047 and.036, respectively). Similarly, the preterm delivery (odds ratio, 0.78; 95% confidence interval, 0.64–0.97) and spontaneous preterm delivery (odds ratio, 0.74; 95% confidence interval, 0.57–0.98) decreased for those inhabiting the neighborhoods in the highest-hardship quartile (Breslow-Day P values.045 and.029, respectively). CONCLUSION The populations residing in socioeconomically disadvantaged neighborhoods experienced reductions in preterm delivery during the COVID-19 pandemic. Neighborhood-level social determinants of health offer insight into the complex etiologies that contribute to preterm delivery and provide opportunities for public health and equity-focused prevention strategies.
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Affiliation(s)
- Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Fisher and Miller); Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Sakowicz); Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, IL (Dr Barnard); Northwestern Medicine Lake Forest Hospital, Lake Forest, IL (Mr Kidder).
| | - Allie Sakowicz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Fisher and Miller); Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Sakowicz); Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, IL (Dr Barnard); Northwestern Medicine Lake Forest Hospital, Lake Forest, IL (Mr Kidder)
| | - Cynthia Barnard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Fisher and Miller); Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Sakowicz); Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, IL (Dr Barnard); Northwestern Medicine Lake Forest Hospital, Lake Forest, IL (Mr Kidder)
| | - Seth Kidder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Fisher and Miller); Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Sakowicz); Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, IL (Dr Barnard); Northwestern Medicine Lake Forest Hospital, Lake Forest, IL (Mr Kidder)
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Fisher and Miller); Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Sakowicz); Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, IL (Dr Barnard); Northwestern Medicine Lake Forest Hospital, Lake Forest, IL (Mr Kidder)
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Murphy L, Liu F. A new perspective on the maternal mortality disparity. Nurs Forum 2021; 57:171-176. [PMID: 34510480 DOI: 10.1111/nuf.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/18/2022]
Abstract
The disparity in maternal mortality rates between ethnicities in the United States is alarming, with Black women at far higher risk of dying than women of other ethnicities. Factors typically thought of as protective in health disparity research are not necessarily protective with maternal mortality. Building upon a social justice framework by utilizing a strength-based focus is needed when addressing this issue to build upon strengths and empower Black women as a part of the solution.
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Affiliation(s)
- Laura Murphy
- College of Nursing, Texas Woman's University, Denton, Texas, USA
| | - Fuqin Liu
- College of Nursing, Texas Woman's University, Denton, Texas, USA
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Palatnik A, Walker RJ, Thakkar MY, Egede LE. Social Adaptability Index and Pregnancy Outcomes in Women With Diabetes During Pregnancy. Diabetes Spectr 2021; 34:268-274. [PMID: 34511853 PMCID: PMC8387617 DOI: 10.2337/ds20-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The social adaptability index (SAI) is a composite indicator capturing an individual's social adaptability within society and socioeconomic status to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women with and without diabetes during pregnancy. METHODS Data from the 2011-2017 National Survey of Family Growth were analyzed using a cross-sectional methodology. Women aged 18-44 years with a singleton gestation were included in the analysis. Maternal diabetes was defined as either presence of pregestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: educational level, employment status, income, marital status, and substance abuse. A higher score indicated lower risk. A series of multivariable logistic regression models were run stratified by maternal diabetes status to assess the association between SAI and pregnancy outcomes, including cesarean delivery, macrosomia (birth weight ≥4,000 g) and preterm birth (<37 weeks). All analyses were weighted and P <0.05 was considered significant. RESULTS A total of 17,772 women were included in the analysis, with 1,965 (10.7%) having maternal diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy compared with control subjects (6.7 ± 0.2 vs. 7.2 ± 0.1, P <0.001). After adjusting for maternal race and ethnicity, insurance status, BMI, age, and partner support of the index pregnancy, SAI was associated with preterm birth among women with diabetes during pregnancy (adjusted odds ratio 0.83, 95% CI 0.72-0.94). The SAI was not significantly associated with cesarean delivery or macrosomia in women with diabetes during pregnancy and was not associated with these outcomes in women without diabetes during pregnancy. CONCLUSION Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm birth. The SAI could be a useful index to identify women at high risk of preterm birth in addition to traditionally defined demographic risk groups among women with diabetes during pregnancy.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Madhuli Y. Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Nijagal MA, Patel D, Lyles C, Liao J, Chehab L, Williams S, Sammann A. Using human centered design to identify opportunities for reducing inequities in perinatal care. BMC Health Serv Res 2021; 21:714. [PMID: 34284758 PMCID: PMC8293556 DOI: 10.1186/s12913-021-06609-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. Methods We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community, with a specific emphasis on representation from marginalized communities. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events and engagement with a diverse community advisory group. Results We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop. Conclusions Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities, and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding and centering the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06609-8.
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Affiliation(s)
- Malini A Nijagal
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF/ZSFG, 1001 Potrero Avenue, Building 5, 6D-9, San Francisco, CA, 94110, USA.
| | - Devika Patel
- Department of Surgery, University of California, San Francisco, USA
| | - Courtney Lyles
- Center for Vulnerable Populations, University of California, San Francisco at San Francisco General Hospital, San Francisco, USA
| | - Jennifer Liao
- Department of Emergency Medicine, Jefferson University, Philadelphia, USA
| | - Lara Chehab
- Department of Surgery, University of California, San Francisco, USA
| | - Schyneida Williams
- Department of Obstetrics, Gynecology and Reproductive Sciences, UCSF/ZSFG, 1001 Potrero Avenue, Building 5, 6D-9, San Francisco, CA, 94110, USA
| | - Amanda Sammann
- Department of Surgery, University of California, San Francisco, USA
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Holcomb DS, Pengetnze Y, Steele A, Karam A, Spong C, Nelson DB. Geographic barriers to prenatal care access and their consequences. Am J Obstet Gynecol MFM 2021; 3:100442. [PMID: 34245930 DOI: 10.1016/j.ajogmf.2021.100442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although prenatal care has long been viewed as an important strategy toward improving maternal morbidity and mortality, limited data exist that support the premise that access to prenatal care impacts perinatal outcomes. Furthermore, little is known about geographic barriers that impact access to care in an underserved population and how this may influence perinatal outcomes. OBJECTIVE This study aimed to (1) evaluate perinatal outcomes among women with and without prenatal care and (2) examine barriers to receiving prenatal care according to block-level data of residence. We hypothesized that women without prenatal care would have worse outcomes and more barriers to receiving prenatal care services. STUDY DESIGN This was a retrospective cohort study of pregnant women delivering at ≥24 weeks' gestation in a large inner-city public hospital system. Maternal and neonatal data were abstracted from the electronic health record and a community-wide data initiative data set, which included socioeconomic and local geographic data from diverse sources. Maternal characteristics and perinatal outcomes were examined among women with and without prenatal care. Prenatal care was defined as at least 1 visit before delivery. Outcomes of interest were (1) preterm delivery at <37 weeks' gestation, (2) preeclampsia or eclampsia, and (3) days in the neonatal intensive care unit after delivery. Barriers to care were analyzed, including public transportation access and location of the nearest county-sponsored prenatal clinic according to block-level location of residence. Statistical analysis included chi-square test and analysis of variance with logistic regression performed for adjustment of demographic features. RESULTS Between January 1, 2019, and October 31, 2019, 9488 women received prenatal care and 326 women did not. Women without prenatal care differed by race and were noted to have higher rates of substance use (P=.004), preterm birth (P<.001), and longer lengths of newborn admission (P<.001). After adjustment for demographic features, higher rates of preterm birth in women without prenatal care persisted (adjusted odds ratio, 2.65; 95% confidence interval, 1.95-3.55). Women without prenatal care resided in areas that relied more on public transportation and required longer transit times (42 minutes vs 30 minutes; P=.005) with more bus stops (29 vs 17; P<.001) to the nearest county-sponsored prenatal clinic. CONCLUSION Women without prenatal care were at a significantly increased risk of adverse pregnancy outcomes. In a large inner city, women without prenatal care resided in areas with significantly higher demands for public transportation. Alternative resources, including telemedicine and ridesharing, should be explored to reduce barriers to prenatal care access.
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Affiliation(s)
- Denisse S Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam).
| | - Yolande Pengetnze
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Ashley Steele
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Albert Karam
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - Catherine Spong
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
| | - David B Nelson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (Drs Holcomb, Spong, and Nelson); Parkland Center for Clinical Innovation, Dallas, TX (Dr Pengetnze, Ms Steele, and Mr Karam)
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Chen KL, Brozen M, Rollman JE, Ward T, Norris KC, Gregory KD, Zimmerman FJ. How is the COVID-19 pandemic shaping transportation access to health care? TRANSPORTATION RESEARCH INTERDISCIPLINARY PERSPECTIVES 2021; 10:100338. [PMID: 34514368 PMCID: PMC8422279 DOI: 10.1016/j.trip.2021.100338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 05/22/2023]
Abstract
The Coronavirus disease 19 (COVID-19) pandemic has disrupted both transportation and health systems. While about 40% of Americans have delayed seeking medical care during the pandemic, it remains unclear to what extent transportation is contributing to missed care. To understand the relationship between transportation and unmet health care needs during the pandemic, this paper synthesizes existing knowledge on transportation patterns and barriers across five types of health care needs. While the literature is limited by the absence of detailed data for trips to health care, key themes emerged across populations and settings. We find that some patients, many of whom already experience transportation disadvantage, likely need extra support during the pandemic to overcome new travel barriers related to changes in public transit or the inability to rely on others for rides. Telemedicine is working as a partial substitute for some visits but cannot fulfill all health care needs, especially for vulnerable groups. Structural inequality during the pandemic has likely compounded health care access barriers for low-income individuals and people of color, who face not only disproportionate health risks, but also greater difficulty in transportation access and heightened economic hardship due to COVID-19. Partnerships between health and transportation systems hold promise for jointly addressing disparities in health- and transportation-related challenges but are largely limited to Medicaid-enrolled patients. Our findings suggest that transportation and health care providers should look for additional strategies to ensure that transportation access is not a reason for delayed medical care during and after the COVID-19 pandemic.
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Affiliation(s)
- Katherine L Chen
- National Clinician Scholars Program, University of California (UCLA), Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Madeline Brozen
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jeffrey E Rollman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tayler Ward
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center & Burnes and Allen Research Institute, Los Angeles, CA, USA
| | - Frederick J Zimmerman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Walton S, Roberson K, Onsomu EO, Hall S, Dearman C. Evaluating Centering group prenatal care in rural women with low socioeconomic status to promote access to care and improve pregnancy outcomes. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Reyes AM, Akanyirige PW, Wishart D, Dahdouh R, Young MR, Estrada A, Ward C, Cruz Alvarez C, Beestrum M, Simon MA. Interventions Addressing Social Needs in Perinatal Care: A Systematic Review. Health Equity 2021; 5:100-118. [PMID: 33778313 PMCID: PMC7990569 DOI: 10.1089/heq.2020.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care. Methods: We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting. Results: Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (n=10) or observational studies (n=7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (n=19). The next most common need addressed was social support (n=5), followed by food insecurity (n=3), and housing (n=2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV. Conclusion: This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.
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Affiliation(s)
- Ana M Reyes
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Danielle Wishart
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rabih Dahdouh
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria R Young
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Araceli Estrada
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Molly Beestrum
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa A Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Svikis DS, Kelpin SS, Keyser-Marcus L, Bishop DL, Parlier-Ahmad AB, Jones H, Villalobos G, Varner SB, Lanni SM, Karjane NW, Cathers LA, Langhorst DM, Masho SW. Increasing Prenatal Care Compliance in At-Risk Black Women: Findings from a RCT of Patient Navigation and Behavioral Incentives. J Racial Ethn Health Disparities 2021; 9:630-640. [PMID: 33620714 DOI: 10.1007/s40615-021-00995-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the USA, infant mortality remains a major public health concern, particularly for Black women and their infants who continue to experience disproportionately high mortality rates. Prenatal care is a key determinant of infant health, with inadequate prenatal care increasing risk for prematurity, stillbirth, neonatal loss, and infant death. The aim of the present study was to determine if concurrent delivery of patient navigation and behavioral incentives to at-risk Black pregnant women could improve prenatal care attendance and associated maternal and infant outcomes. METHODS Participants were 150 Black pregnant women recruited at first prenatal visit and screening at risk for adverse maternal and infant outcomes. Women were randomized to either the patient navigation + behavioral incentives intervention (PNBI) or assessment + standard care control (ASC) group. All were followed throughout pregnancy and 12-week postpartum. Group comparisons were made using intention-to-treat and per-protocol sensitivity analyses. RESULTS While no group differences were found in prenatal care visits, the average number of visits for both groups (9.3 for PNBI and 8.9 for ASC) approached the American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. There were also no group differences in maternal and infant outcomes. Both intention-to-treat and per-protocol sensitivity analyses, however, consistently found PNBI women attended more postpartum visits than ASC controls (p = 0.002). CONCLUSIONS Given ACOG's redefining of the postpartum period as the fourth trimester, study findings suggest PNBI may facilitate prevention and intervention efforts to more successfully reduce health disparities in outcomes for both mother and infant.
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Affiliation(s)
- Dace S Svikis
- Department of Psychology and Institute for Women's Health, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA.
| | - Sydney S Kelpin
- Department of Psychology and Institute for Women's Health, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
| | - Lori Keyser-Marcus
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Diane L Bishop
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Anna Beth Parlier-Ahmad
- Department of Psychology and Institute for Women's Health, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
| | - Heather Jones
- Department of Psychology and Institute for Women's Health, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
| | - Gabriela Villalobos
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara B Varner
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan M Lanni
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole W Karjane
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauretta A Cathers
- Department of Health-Related Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Diane M Langhorst
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Saba W Masho
- Institute for Women's Health, Virginia Commonwealth University, Richmond, VA, USA
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Testa A, Jackson DB. Barriers to Prenatal Care Among Food-Insufficient Women: Findings from the Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2021; 30:1268-1277. [PMID: 33416423 DOI: 10.1089/jwh.2020.8712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study examines the relationship among food insufficiency, adequacy of prenatal care, and barriers to prenatal care. Materials and Methods: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2016, negative binomial and logistic regression models were used to assess the association among food insufficiency during pregnancy, late onset of prenatal care, the number of prental care visits, as well as barriers to prenatal care. Results: Findings indicate that food insufficiency is associated with not initiating prenatal care during the first trimester and having fewer overall visits. In addition, food insufficiency is associated with more overall barriers to prenatal care, and this association operates through several specific barriers, including not having enough money, lacking transportation to get to the clinic or doctor's office, not being able to get time off work, not having a Medicaid card, having too many other things going on, and having no one to take care of children. Conclusion: Considering the adverse consequences of both food insufficiency and a lack of sufficient prenatal care for maternal and child health, study findings suggest a need to develop targeted interventions that expand access and remove barriers to prenatal care among food-insufficient women.
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Affiliation(s)
- Alexander Testa
- Department of Criminology and Criminal Justice, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
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Alhusen JL, Bloom T, Laughon K, Behan L, Hughes RB. Perceptions of barriers to effective family planning services among women with disabilities. Disabil Health J 2020; 14:101055. [PMID: 33384277 DOI: 10.1016/j.dhjo.2020.101055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with disabilities have the same rights as women without disabilities to prevent unintended pregnancy, yet little is known about their experiences in accessing family planning methods. OBJECTIVE This qualitative descriptive study explored perceptions of barriers to effective family planning services among women with disabilities. METHOD Semi-structured, open-ended interviews were conducted with 31 women with diverse disabilities as part of a larger study investigating risks and facilitators of unintended pregnancy among women with disabilities across the United States. RESULTS Analysis revealed multiple barriers experienced by women with disabilities in accessing effective family planning services needed to prevent unintended pregnancy. Barriers included physical or system barriers, financial limitations, and nonresponsive healthcare providers. Women also identified difficulties in finding appropriate family planning methods, both related and unrelated to disability. CONCLUSIONS This is the first in-depth exploration of barriers to accessing family planning services and challenges to finding effective family planning options among women with disabilities. The findings underscore the need for targeted interventions, improved provider training, and policy changes to optimize reproductive healthcare, improve access to family planning services, and prevent unintended pregnancy among women of childbearing age with diverse disabilities.
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Affiliation(s)
- Jeanne L Alhusen
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA.
| | - Tina Bloom
- University of Missouri Sinclair School of Nursing, S421 Sinclair School of Nursing, Columbia, MO, 65211, USA
| | - Kathryn Laughon
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA
| | - Lillian Behan
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA
| | - Rosemary B Hughes
- University of Montana Rural Institute for Inclusive Communities, 52 Corbin Hall, Missoula, MT, 59812, USA
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Gad MM, Elgendy IY, Mahmoud AN, Saad AM, Isogai T, Sande Mathias I, Misbah Rameez R, Chahine J, Jneid H, Kapadia SR. Disparities in Cardiovascular Disease Outcomes Among Pregnant and Post-Partum Women. J Am Heart Assoc 2020; 10:e017832. [PMID: 33322915 PMCID: PMC7955477 DOI: 10.1161/jaha.120.017832] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited. Methods and Results Pregnant and post‐partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in‐hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in‐hospital outcomes. Among 46 700 637 pregnancy‐related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 065 (19.1%) were Hispanic. The trends of mortality and stroke declined significantly in Black women, but however, were mostly unchanged among White women. The incidence of mortality and cardiovascular morbidity was highest among Black women followed by White women, then Hispanic women. The majority of Blacks (62.3%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of Black women were below‐median income (71.2%) while over half of the White patients were above the median income (52.7%). Compared with White women, Black women had the highest mortality with adjusted odds ratio (aOR) of 1.45, 95% CI (1.21–1.73); myocardial infarction with aOR of 1.23, 95% CI (1.06–1.42); stroke with aOR of 1.57, 95% CI (1.41–1.74); pulmonary embolism with aOR of 1.42, 95% CI (1.30–1.56); and peripartum cardiomyopathy with aOR of 1.71, 95 % CI (1.66–1.76). Conclusions Significant racial disparities exist in major cardiovascular events among pregnant and post‐partum women. Further efforts are needed to minimize these differences.
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Affiliation(s)
| | - Islam Y Elgendy
- Division of Cardiology Weill Cornell Medicine-Qatar Doha Qatar
| | - Ahmed N Mahmoud
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteCase Western Reserve University Cleveland OH
| | | | | | | | | | - Johnny Chahine
- Division of Cardiology University of Minnesota Minneapolis MN
| | - Hani Jneid
- Section of Cardiology Baylor School of Medicine Houston TX
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Beecher C, Devane D, White M, Greene R, Dowling M. Women’s experiences of their maternity care: A principle- based concept analysis. Women Birth 2020; 33:419-425. [DOI: 10.1016/j.wombi.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/03/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
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Fryer K, Delgado A, Foti T, Reid CN, Marshall J. Implementation of Obstetric Telehealth During COVID-19 and Beyond. Matern Child Health J 2020; 24:1104-1110. [PMID: 32564248 PMCID: PMC7305486 DOI: 10.1007/s10995-020-02967-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth. DESCRIPTION The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations-including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing. ASSESSMENT The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care. CONCLUSION Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.
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Affiliation(s)
- Kimberly Fryer
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA.
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA
| | - Tara Foti
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Chinyere N Reid
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jennifer Marshall
- Sunshine Education and Research Center, Chiles Center College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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Altman MR, McLemore MR, Oseguera T, Lyndon A, Franck LS. Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care. J Midwifery Womens Health 2020; 65:466-473. [PMID: 32558179 DOI: 10.1111/jmwh.13102] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. METHODS Twenty-two women of color living in the San Francisco Bay Area and receiving support services from a community-based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio-recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. RESULTS Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person-centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. DISCUSSION Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community-centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.
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Affiliation(s)
- Molly R Altman
- University of Washington School of Nursing, Seattle, Washington.,Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
| | - Talita Oseguera
- University of California, San Francisco School of Nursing, San Francisco, California
| | - Audrey Lyndon
- New York University Rory Meyers College of Nursing, New York, New York
| | - Linda S Franck
- Preterm Birth Initiative, University of California San Francisco, San Francisco, California.,University of California, San Francisco School of Nursing, San Francisco, California
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Fryer K, Munoz MC, Rahangdale L, Stuebe AM. Multiparous Black and Latinx Women Face More Barriers to Prenatal Care than White Women. J Racial Ethn Health Disparities 2020; 8:80-87. [PMID: 32333378 DOI: 10.1007/s40615-020-00759-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Women who are late to prenatal care miss opportunities for health interventions and are at increased risk for pregnancy-related complications. Black women have the lowest rates of first trimester care compared with White or Latinx women. We sought to describe barriers to prenatal care experienced by race/ethnicity in a multi-site, prospective cohort. STUDY DESIGN We performed a secondary analysis of the Community Child Health Research Network Study, a multi-site prospective cohort study of pregnant women from 2008 to 2012. Women were recruited at the time of delivery and followed prospectively for 2 years. Participants who experienced a repeat pregnancy in the 2-year follow-up period had a prospective assessment of prenatal care barriers. A multilevel mixed effects Poisson regression was performed to evaluate the association between race/ethnicity and number of prenatal barriers. RESULTS Of the 298 participants in the sample, 43% of Black, 35% of Latinx, and 23% of White participants reported barriers to prenatal care. After adjustment for confounders, Black and Latinx women reported almost twice as many barriers to prenatal care as White women (adjusted rate ratio 1.89 [1.2, 3.0]; 2.00 [1.1, 3.8], respectively). CONCLUSION In our analysis, multiparous Black and Latinx women reported encountering more barriers to prenatal care than White women. Additional reforms and policy change are needed at the clinic, local, and state levels to support women in accessing early quality prenatal care to achieve racial equity in prenatal care.
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Affiliation(s)
- Kimberly Fryer
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
| | - Maria Christina Munoz
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Effect of the Medicaid Primary Care Rate Increase on Prenatal Care Utilization Among Medicaid-Insured Women. Matern Child Health J 2020; 23:1564-1572. [PMID: 31240426 DOI: 10.1007/s10995-019-02804-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity. METHODS We employed a difference-in-differences design, using births data from the 2010-2014 National Vital Statistics System. Our study population included approximately 6.2 million births to Medicaid insured mothers conceived between April 2009 and March 2014. Our treatment group was births in states with large (relative to small) fee bump, defined as having Medicaid-to-Medicare fee ratio below the median of all states (0.7) in 2012. Our control group was births in states with a small fee bump. Prenatal care utilization measures included initiation of prenatal care in the first trimester and number of prenatal care visits. RESULTS Non-Hispanic Black women giving births in large fee bump states had 9% higher odds (95% CI 1.02, 1.17) of initiating prenatal care in the first trimester during the fee bump period, compared to small fee bump states. Prenatal care visits in this group also increased by 0.24 (95% CI 0.10, 0.39), 2.4% of the mean. A smaller increase in prenatal care visits of 0.17 (95% CI 0.00, 0.33) was found among non-Hispanic Whites. The fee bump had no impact among Hispanics or non-Hispanic women of other races. CONCLUSIONS FOR PRACTICE The Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. Policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
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Alhusen JL, Bloom T, Anderson J, Hughes RB. Intimate partner violence, reproductive coercion, and unintended pregnancy in women with disabilities. Disabil Health J 2019; 13:100849. [PMID: 31679950 DOI: 10.1016/j.dhjo.2019.100849] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Women with disabilities experience higher rates of intimate partner violence (IPV) than the general population. Reproductive coercion, a type of intimate partner violence, is associated with an increased risk of unintended pregnancy (UIP), yet little is known about this relationship among women with disabilities. OBJECTIVE This qualitative descriptive study explored perspectives of women with disabilities who had experienced an UIP as a result of reproductive coercion. METHOD In-depth, semi-structured telephone interviews were conducted with nine women living with diverse disabilities across the United States as part of a larger study examining facilitators and barriers to UIP among women with disabilities. RESULTS Analysis revealed three broad themes related to the ways in which physical violence and reproductive coercion elevated women's risk of UIP. They included (1) inadequate health care provider or system response, (2) disability-related risks for IPV, and (3) resource needs to optimize safety. CONCLUSIONS This is the first in-depth exploration of ways in which reproductive coercion may lead to an increased risk of UIP among women with disabilities. Health care providers must screen for IPV and reproductive coercion and provide the necessary supports and resources for women with disabilities experiencing unintended pregnancy as a result of violence.
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Affiliation(s)
- Jeanne L Alhusen
- University of Virginia School of Nursing 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA.
| | - Tina Bloom
- University of Missouri Sinclair School of Nursing, S421 Sinclair School of Nursing, Columbia, MO, 65211, USA
| | - Jacqueline Anderson
- University of Virginia School of Nursing 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA
| | - Rosemary B Hughes
- University of Montana Rural Institute for Inclusive Communities, 52 Corbin Hall, Missoula, MT, 59812, USA
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Howell EA, Ahmed ZN, Sofaer S, Zeitlin J. Positive Deviance to Address Health Equity in Quality and Safety in Obstetrics. Clin Obstet Gynecol 2019; 62:560-571. [PMID: 31206366 PMCID: PMC6988184 DOI: 10.1097/grf.0000000000000472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Racial/ethnic disparities persist in obstetrical outcomes. In this paper, we ask how research in obstetrical quality can go beyond a purely quantitative approach to tackle the challenge of health inequity in quality and safety. This overview debriefs the use of positive deviance and mixed methods in others areas of medicine, describes the shortcomings of quantitative methods in obstetrics and presents qualitative studies carried out in obstetrics as well as the insights provided by this method. The article concludes by proposing positive deviance as a mixed methods approach to generate new knowledge for addressing racial and ethnic disparities in maternal outcomes.
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Affiliation(s)
- Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute
- Departments of Population Health Science & Policy
- Obstetrics, Gynecology, and Reproductive Science
| | - Zainab N Ahmed
- Departments of Population Health Science & Policy
- Obstetrics, Gynecology, and Reproductive Science
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, District of Columbia
| | - Jennifer Zeitlin
- Departments of Population Health Science & Policy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Vulnerable Women’s Perceptions of Individual Versus Group Prenatal Care: Results of a Cross-Sectional Survey. Matern Child Health J 2018; 22:1632-1638. [DOI: 10.1007/s10995-018-2559-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Castle B, Wendel M, Kerr J, Brooms D, Rollins A. Public Health’s Approach to Systemic Racism: a Systematic Literature Review. J Racial Ethn Health Disparities 2018; 6:27-36. [DOI: 10.1007/s40615-018-0494-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
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Coley SL, Zapata JY, Schwei RJ, Mihalovic GE, Matabele MN, Jacobs EA, Anderson CK. More Than a "Number": Perspectives of Prenatal Care Quality from Mothers of Color and Providers. Womens Health Issues 2018; 28:158-164. [PMID: 29208354 PMCID: PMC5835403 DOI: 10.1016/j.whi.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/19/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION African American mothers and other mothers of historically underserved populations consistently have higher rates of adverse birth outcomes than White mothers. Increasing prenatal care use among these mothers may reduce these disparities. Most prenatal care research focuses on prenatal care adequacy rather than concepts of quality. Even less research examines the dual perspectives of African American mothers and prenatal care providers. In this qualitative study, we compared perceptions of prenatal care quality between African American and mixed race mothers and prenatal care providers. METHODS Prenatal care providers (n = 20) and mothers who recently gave birth (n = 19) completed semistructured interviews. Using a thematic analysis approach and Donabedian's conceptual model of health care quality, interviews were analyzed to identify key themes and summarize differences in perspectives between providers and mothers. FINDINGS Mothers and providers valued the tailoring of care based on individual needs and functional patient-provider relationships as key elements of prenatal care quality. Providers acknowledged the need for knowing the social context of patients, but mothers and providers differed in perspectives of "culturally sensitive" prenatal care. Although most mothers had positive prenatal care experiences, mothers also recalled multiple complications with providers' negative assumptions and disregard for mothers' options in care. CONCLUSIONS Exploring strategies to strengthen patient-provider interactions and communication during prenatal care visits remains critical to address for facilitating continuity of care for mothers of color. These findings warrant further investigation of dual patient and provider perspectives of culturally sensitive prenatal care to address the service needs of African American and mixed race mothers.
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Affiliation(s)
- Sheryl L Coley
- Health Disparities Research Scholars Program, University of Wisconsin Madison, Madison, Wisconsin; Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin.
| | - Jasmine Y Zapata
- Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin; Preventive Medicine and Public Health Residency Program, University of Wisconsin Madison, Madison, Wisconsin
| | - Rebecca J Schwei
- Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin; BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin
| | | | - Maya N Matabele
- Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin; University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Elizabeth A Jacobs
- Department of Medicine, University of Wisconsin Madison, Madison, Wisconsin; Dell Medical School, University of Texas Austin, Austin, Texas
| | - Cynthie K Anderson
- Department of Obstetrics & Gynecology, University of Wisconsin Madison, Madison, Wisconsin
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Haddrill R, Jones GL, Anumba D, Mitchell C. A tale of two pregnancies: A Critical Interpretive Synthesis of women's perceptions about delayed initiation of antenatal care. Women Birth 2017; 31:220-231. [PMID: 29037485 DOI: 10.1016/j.wombi.2017.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Delayed access to antenatal care in high income countries is associated with poor maternal, fetal and neonatal outcomes. The aim was to synthesise the diverse body of evidence around women's views of early antenatal care and barriers to attendance in such countries. Critical Interpretive Synthesis integrates the process of systematic review with the qualitative methods of meta-ethnography and grounded theory, with a focus on theory generation to inform policy, practice and future research. METHODS Database searches were conducted, supplemented with reference and citation tracking and website searching between February 2014 and April 2016. Qualitative data analysis methods were used to extract and summarise the key themes from each study. A taxonomy of constructs was created, with the synthesis developed to thread these together. Fifty-four papers were synthesised, including qualitative, quantitative, mixed method and systematic review, published between 1987 and 2016. FINDINGS Seventeen constructs around the core concept of 'acceptance of personal and public pregnancies' were produced. Acceptance of the 'personal' pregnancy considers the contribution of mindset in the recognition and acceptance of pregnancy, influenced by knowledge of pregnancy symptoms, pregnancy planning and desire. Acceptance of the 'public' pregnancy considers women's assessment of the social consequences of pregnancy, and the relevance and priority of antenatal care. CONCLUSION Critical Interpretive Synthesis offers a systematic yet creative approach to the synthesis of diverse evidence. The findings offer new perspectives on women's perceptions of early pregnancy and attendance for care, which may be used to facilitate timely antenatal provision for all pregnant women.
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Affiliation(s)
- Rosalind Haddrill
- Academic Unit of Midwifery, Social Work, Pharmacy, Counselling & Psychotherapy, School of Healthcare, University of Leeds, Baines Wing, Leeds LS2 9JT, UK.
| | - Georgina L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds LS1 9HE, UK
| | - Dilly Anumba
- Academic Unit of Reproductive and Developmental Medicine-Obstetrics and Gynaecology Department of Oncology and Metabolism, The University of Sheffield 4th Floor, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sam Fox House, Northern General Hospital, Sheffield S5 7AU, UK
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50
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Mehta PK, Carter T, Vinoya C, Kangovi S, Srinivas SK. Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status. Womens Health Issues 2017; 27:441-448. [PMID: 28286001 DOI: 10.1016/j.whi.2017.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/18/2022]
Abstract
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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Affiliation(s)
- Pooja K Mehta
- Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania/ Department of Veterans Affairs, Philadelphia, Pennsylvania.
| | - Tamala Carter
- Penn Center for Community Health Workers, Philadelphia, Pennsylvania
| | - Cjloe Vinoya
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shreya Kangovi
- Penn Center for Community Health Workers, Philadelphia, Pennsylvania; Department of Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sindhu K Srinivas
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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