First Steps: participants and outcomes of a maternity support services program

Social Support and Smoking during Pregnancy

BACKGROUND

Smoking during pregnancy and a lack of social support have been identified as independent risk factors for poor birth outcomes. However, the influence of social support on smoking during pregnancy remains under-investigated. This study examined the association between domains of social support and smoking during pregnancy.

METHODS

Pregnant women during their first trimester, attending three inner-city clinics were surveyed using self-administered questionnaires (N=227). Social support was measured using the Interpersonal Support Evaluation List (ISEL). Three domains of social support (tangible, appraisal, and belonging) were examined. Multiple logistic regressions were conducted; Odds Ratios (OR) and 95% confidence intervals were calculated.

RESULTS

Per unit increase in the total composite social support scale, there was a 6% increased odds of smoking during pregnancy. There was a statistically significant interaction between race and social support. While the tangible support (OR=1.15; 95% CI: 1.03, 1.27) and appraisal (OR=1.17; 95% CI: 1.05, 1.31) domains were significantly associated with smoking among African American women, only the belonging support domain was significantly associated with smoking during pregnancy among Caucasian women (OR=1.20; 95% CI: 1.02, 1.40).

CONCLUSIONS

This study provided evidence that racial differences may exist in the way social support influences smoking during pregnancy. Future studies are needed to understand these racial differences and assist in the design of interventions. Considering the importance of social support, strategies for smoking cessation intervention should consider racial difference.

Social and Professional Support for Pregnant and Parenting Women

PURPOSE

A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women.

DATA SOURCES

Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts).

STUDY SELECTION

The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered.

DATA EXTRACTION

Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes.

DATA SYNTHESIS

Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes.

CONCLUSIONS

Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Women's perceptions of outcomes of prenatal case management

BACKGROUND

Comprehensive case management is a multidisciplinary, community-based service often available to Medicaid-eligible women. The purpose of the study was to identify the variety of maternal outcomes, other than birth outcomes, attributable to comprehensive prenatal case management.

METHOD

This qualitative study used a social ecological approach. Twenty-four women were interviewed about the outcomes they experienced as a result of comprehensive prenatal case management. Ethnographic content analysis was used for data reduction. The participants' mean age was 25.4 (SD = 8.4) years, with an average parity of 1.9 (SD = 1.1). Fifteen participants (68%) had a 12th grade education or less. Ethnic minorities were included in the sample. Eleven participants (47%) worked at least part-time, although 23 (98%) were receiving Medicaid and 21 (88%) were receiving the Women, Infants, and Children's (WIC) supplementary nutrition program.

RESULTS

The women attributed improvements of various types to the actions of the case manager, specifically in the areas of emotional well-being, learning, lifestyle behaviors, financial situation, services utilization, and maternal and infant physical health.

CONCLUSION

Case management appeared to have immediate effects on the women, as well as intermediate effects, such as changes in lifestyle behaviors and services utilization. The women attributed those changes to having a healthy pregnancy.

Designing a care pathway for a maternity support service program in a rural health department

Today's heath care system in the United States faces many financial dilemmas related to the country's current economic status. Despite dwindling resources, the health care system must continue to provide high quality care to meet ever-increasing demands (Ferguson, 1993). Care pathways are an example of case management tools which provide care coordination. With an interdisciplinary approach, pathways increase communication and continuity of care between service disciplines, as well as improve efficient resource utilization. The purpose of this paper was to review: (1) the literature related to the benefits of using care pathways to enhance client care; (2) the benefits of public health nurse home visitation to pregnant and postpartum women; and (3) to describe the process to design a care pathway for the Maternity Support Service (MSS) program at a rural health department. This health department provides MSS to a county with a population of 65,000, with over 900 births per year. The county is 100 miles wide and 28 miles long. Thus, the MSS staff cover a large area, and needed a method to maximize efficient use of staff time. Care pathways have tremendous appeal because they accommodate interdisciplinary teams of care, focus on process, reduce unnecessary variation in care, and attend to quality and client outcomes.

Effects of social support on prenatal care and health behaviors of low-income women

OBJECTIVE

To determine the relationship of social support from partners and others to the adequacy of prenatal care and to the prenatal health behaviors of low-income women.

DESIGN

Descriptive, correlational study using self-reports and medical record review.

SETTING

Data were collected in five metropolitan prenatal clinics serving low-income women.

PARTICIPANTS

Ethnically diverse, primarily single, low-income pregnant women (N = 101) between 28 and 40 weeks of pregnancy.

MAIN OUTCOME MEASURES

Subjects completed the Norbeck Social Support Questionnaire, the Prenatal Health Questionnaire, and the Demographic/Pregnancy Questionnaire.

RESULTS

Social support provided by the partner correlated positively with adequacy of prenatal care, whereas social support from others (excluding partner relationships) correlated positively with prenatal health behaviors. Professionals such as health care providers and counselors were not considered sources of social support by women.

CONCLUSIONS

Nurses who work with low-income pregnant women in a variety of settings should assist partners in recognizing their potential positive contributions, teach women to communicate their expectations to their partners, acknowledge the importance of other family members as providers of social support, and when needed, refer women to programs that increase available social support.

Staff evaluation of a high-risk pregnancy program

A southeastern state implemented a multidisciplinary health care program for Medicaid eligible, medically high-risk pregnant women and their infants as part of a statewide effort to reduce perinatal morbidity and mortality. The purpose of this study was to obtain the staff's evaluation of this high-risk-pregnancy program. Clinical, supervisory, and clerical staff (N = 182) completed a questionnaire about the operation of the program and its perceived benefits. Staff identified program strengths: nurse case management, interdisciplinary structure, quality care, and positive health outcomes. Staff also identified program limitations including limited staff and time, inflexible protocols, administrative tasks, and narrow enrollment criteria. The majority of staff reported that the following barriers interfered with the effective operation of the program: paperwork, limited support, time, difficulty locating patients, and mandated time frames for patient contact. The majority of staff also reported that transportation most interfered with patient access to the program. The findings of this study support the need for ongoing staff evaluation of all perinatal health care programs.