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Nair NM, Makhanlall A, Roy S, Olola O, Altman E, Chaudhuri P, Wen X. Predictors of Quitting Dual Use of Electronic Cigarettes and Cigarettes During Pregnancy. J Womens Health (Larchmt) 2024; 33:239-253. [PMID: 38112533 PMCID: PMC10880298 DOI: 10.1089/jwh.2023.0179] [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: 12/21/2023] Open
Abstract
Background and Aims: There is limited research surrounding dual maternal use of cigarettes and electronic cigarettes (e-cigarettes). We aimed to assess predictors of maternal quitting of cigarettes, e-cigarettes, and both during late pregnancy. Materials and Methods: We analyzed dual use (n = 4,006) and exclusive e-cigarette use (n = 1,685) among mothers using data from the 2016 to 2019 phase of the Pregnancy Risk Assessment Monitoring Systems (PRAMS), a nationally representative sample of the United States. Dual use and exclusive e-cigarette use were defined based on use reported during the 3 months before pregnancy and quitting was assessed during the last 3 months of pregnancy. Multinomial and binomial logistic regression models estimated the odds ratios and 95% confidence intervals for predictors of quitting status among mothers who reported dual use and exclusive e-cigarette use, respectively. Separate predictor analyses were conducted in the dual and exclusive e-cigarette use groups to see predictors of quitting e-cigarettes, cigarettes, or both. Results: The highest proportion of mothers who used cigarettes and e-cigarettes before pregnancy quit both during late pregnancy (46.2%), followed by those who quit e-cigarette use only (26.5%) and those who quit cigarette use only (6.6%). Among mothers who reported dual use, those who were African American or Asian, of Hispanic ethnicity, consumed alcohol before pregnancy, had higher education, were married, had diabetes, had higher annual household income, had nongovernmental health insurance, had more prenatal care visits, had a higher frequency of e-cigarette use before pregnancy, had a lower frequency of cigarette use before pregnancy, and smoked hookah around pregnancy had a higher likelihood of quitting both cigarette and e-cigarette use during late pregnancy. Conclusions: Quitting use of cigarettes and/or e-cigarettes was fairly common among mothers who reported dual use or e-cigarette use only. Sociodemographics, pregnancy characteristics, and use of other tobacco products predicted quitting use of both cigarettes and e-cigarettes during late pregnancy.
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Affiliation(s)
- Nisha M. Nair
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Amelia Makhanlall
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Shannon Roy
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Olabowale Olola
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elizabeth Altman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Preyashi Chaudhuri
- Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, New York, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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2
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Thai A, Johnson KM. Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes. South Med J 2022; 115:893-898. [DOI: 10.14423/smj.0000000000001483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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3
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Geda NR, Feng CX, Henry CJ, Lepnurm R, Janzen B, Whiting SJ. Inequalities in adherence to the continuum of maternal and child health service utilization in Ethiopia: multilevel analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:45. [PMID: 34717779 PMCID: PMC8557495 DOI: 10.1186/s41043-021-00271-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/18/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Despite progress made to improve access to child health services, mothers' consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use. METHOD The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services. RESULTS The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization. CONCLUSION The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services.
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Affiliation(s)
- Nigatu Regassa Geda
- Center for Population Studies, College of Development Studies, Addis Ababa University, Sidist Kilo Campus, PO Box 1176, Addis Ababa, Ethiopia
| | - Cindy Xin Feng
- School of Public Health, Health Science E-Wing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Carol J. Henry
- College of Pharmacy and Nutrition, Health Sciences A-Wing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Rein Lepnurm
- School of Public Health, Health Science E-Wing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, Collège of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Susan J. Whiting
- College of Pharmacy and Nutrition, Health Sciences A-Wing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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4
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Vestal NL, Sangara RN, Mandelbaum RS, Matsuzaki S, McCarthy LE, Matsushima K, Yoshihara K, Klar M, Lee RH, Ouzounian JG, Matsuo K. Racial and ethnic disparity in characteristics and outcomes of women with placenta accreta spectrum: a comparative study. Reprod Sci 2021; 29:1988-2000. [PMID: 34716538 DOI: 10.1007/s43032-021-00781-2] [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: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
Placenta accreta spectrum (PAS) refers to the spectrum of diagnoses involving abnormally and morbidly adherent trophoblastic tissue to the gravid uterus. These disorders are associated with significant maternal morbidity and mortality. While race/ethnicity is known to impact pregnancy outcomes, racial disparities have not been previously examined in women with PAS. The objective of current study was to compare patient characteristics and perioperative outcomes of women with PAS who underwent cesarean delivery across race/ethnicity. This is a comparative study that retrospectively queried the National Inpatient Sample, a hospital-based inpatient database in the USA. The study cohort was women diagnosed with PAS who underwent cesarean delivery from 10/2015 to 12/2018. The exposure group was race/ethnicity. Main outcomes were (i) patient/pregnancy characteristics and (ii) surgical morbidity for cesarean delivery, assessed in multivariable analysis. A total of 10,535 women comprised the study cohort (White n = 5,230 [49.6%], Black n = 2,045 [19.4%], Hispanic n = 2,540 [24.1%], and Asian n = 720 [6.8%]). Patient demographics, pregnancy characteristics, and hospital factors for the non-White groups significantly differed compared to the White group. Older age, obesity, diabetes, placenta previa, percreta, non-elective surgery, lower median household income, and Medicaid particularly represented the non-White groups. When perioperative outcomes were compared, non-White women were more likely to have any measured complications, hemorrhage/transfusion, and shock/coagulopathy compared to White women. Various sensitivity analyses redemonstrated the main cohort results. In conclusion, this study suggests that there were significant disparities in patient characteristics and outcomes of women with PAS across race/ethnicity.
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Affiliation(s)
- Nicole L Vestal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rauvynne N Sangara
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA
| | - Lauren E McCarthy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Richard H Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA. .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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5
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Jamieson B. Exposure to Interpersonal Violence During Pregnancy and Its Association With Women's Prenatal Care Utilization: A Meta-Analytic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:904-921. [PMID: 30322355 DOI: 10.1177/1524838018806511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation (k = 9) and (2) delayed entry into prenatal care (k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care (OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.
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Affiliation(s)
- Brittany Jamieson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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6
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Development and psychometric properties of maternal health literacy inventory in pregnancy. PLoS One 2020; 15:e0234305. [PMID: 32525889 PMCID: PMC7289409 DOI: 10.1371/journal.pone.0234305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 05/22/2020] [Indexed: 11/19/2022] Open
Abstract
Background Pregnancy is one of the most sensitive and important stages of women's life. Maternal health literacy is the key to achieving a healthy pregnancy. It also affects pregnancy outcomes by improving the quality of health care in this period. The aim of this study was to develop and evaluate the psychometric properties of maternal health literacy inventory in pregnancy (MHELIP). Methods This sequential, exploratory and mixed study was carried out in two parts (qualitative study and psychometric evaluation of the tool) in Tehran in 2016–18. The first part involved a qualitative content analysis with a traditional approach using in-depth, semi-structured and personal interviews with 19 eligible pregnant women. Then, the pool of items extracted from the qualitative part was completed by reviewing the existing literature and tools. In the second part, the overlapping items were summarized and the tool was validated. In order to evaluate the construct validity, a cross-sectional study was conducted with the participation of 320 pregnant women. Data analysis was performed by SPSS-19 software using exploratory factor analysis and reliability tests (Cronbach's alpha and ICC). Results Findings of qualitative part produced a pool of 120 items that reached to 124 items after reviewing the literature. After confirming face and content validity by calculating CVI and CVR for each item, 53 items remained in the pool. Finally, the results of exploratory factor analysis confirmed a tool with 48 items in four factors, explaining 46.49% of the variance of total variables of the tool. Reliability of the tool was approved by Cronbach's alpha = 0.94 and test-retest with 2-weeks intervals, indicating an appropriate stability for the scale (ICC = 0.96). Finally, the tool was finalized with 48 items in 4 dimensions, including "Maternal Health Knowledge", "Maternal Health Information Search", "Maternal Health Information Assessment" and "Maternal Health Decision Making and Behavior". Conclusion The designed tool is a multidimensional, reliable and validated scale for assessing maternal health literacy during pregnancy. This tool can be used to evaluate different aspects of maternal health literacy in pregnant women, which was prepared based on their experiences during a qualitative study.
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Poleshuck E, Wittink M, Crean HF, Juskiewicz I, Bell E, Harrington A, Cerulli C. A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral. J Womens Health (Larchmt) 2019; 29:242-252. [PMID: 31502906 DOI: 10.1089/jwh.2018.7640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Despite recent widespread acceptance that unmet social needs are critically relevant to health, limited guidance exists about how best to address them in the context of women's health care delivery. We aimed to evaluate two interventions: enhanced screening and referral (ESR), a screening intervention with facilitated referral and follow-up calls, and personalized support for progress (PSP), a community health worker intervention tailored to women's priorities. Materials and Methods: Women >18 years were screened for presence of elevated depressive symptoms in three women's health clinics serving primarily Medicaid-eligible patients. If eligible and interested, we enrolled and randomized women to ESR or PSP. Pre- and postintervention assessments were conducted. Primary outcomes were satisfaction, depression, and quality of life (QOL). Planned analyses of subgroup differences were also explored. Results: A total of 235 participants were randomized; 54% identified as African American, 19% as White, and 15% as Latina. Participant mean age was 30 years; 77% reported annual incomes below US $20,000/year; and 30% were pregnant at enrollment. Participants in both arms found the interventions satisfactory and improved for depression (p < 0.001). There were no differences between groups for the primary outcomes. Subgroups reporting greater improvement in QOL in PSP compared with ESR included participants who at baseline reported anxiety (p = 0.05), lack of access to depression treatment (p = 0.02), pain (p = 0.04), and intimate partner violence (p = 0.02). Conclusions: Clinics serving women with unmet social needs may benefit from offering PSP or ESR. Distinguishing how best to use these interventions in practice is the next step.
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Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Hugh F Crean
- School of Nursing, University of Rochester, Rochester, New York
| | - Iwona Juskiewicz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Elaine Bell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Amy Harrington
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Susan B. Anthony Center, University of Rochester, Rochester, New York
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8
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Saleh L. Women's Perceived Quality of Care and Self-Reported Empowerment With CenteringPregnancy Versus Individual Prenatal Care. Nurs Womens Health 2019; 23:234-244. [PMID: 31075219 DOI: 10.1016/j.nwh.2019.03.008] [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: 05/11/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare perceived quality of prenatal care and pregnancy-related self-reported empowerment between women participating in CenteringPregnancy versus those receiving individual prenatal care provided by certified nurse-midwives in the same clinic. DESIGN Nonexperimental, longitudinal, descriptive feasibility study of two independent groups. SETTING/LOCAL PROBLEM A prenatal clinic in northern Texas where all care is provided by certified nurse-midwives. PARTICIPANTS The study assessed 51 women receiving self-selected prenatal care in the form of individual prenatal care (n = 37) or CenteringPregnancy (n = 14). INTERVENTION/MEASUREMENTS Outcomes analyzed included perceived quality of prenatal care and pregnancy-related self-reported empowerment. RESULTS The results showed no statistical significance between the individual prenatal care and CenteringPregnancy groups with regard to perceived quality of prenatal care or pregnancy-related self-reported empowerment. CONCLUSION CenteringPregnancy has the capability to provide women with quality of care equal to that achieved through traditional prenatal care. Despite the lack of statistically significant findings, this study exposes several areas of interest and provides guidance for future studies evaluating prenatal care.
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Adams EK, Dunlop AL, Strahan AE, Joski P, Applegate M, Sierra E. Prepregnancy Insurance and Timely Prenatal Care for Medicaid Births: Before and After the Affordable Care Act in Ohio. J Womens Health (Larchmt) 2019; 28:654-664. [DOI: 10.1089/jwh.2017.6871] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Esther Kathleen Adams
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea E. Strahan
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Peter Joski
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Applegate
- Ohio Department of Medicaid, Columbus, Ohio
- Ohio State University College of Medicine, Columbus, Ohio
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Fekadu GA, Ambaw F, Kidanie SA. Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey. BMC Pregnancy Childbirth 2019; 19:64. [PMID: 30744583 PMCID: PMC6371418 DOI: 10.1186/s12884-019-2216-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Antenatal care provides the best opportunity to promote maternal and child health services use. But many Ethiopian mothers deliver at home and fail to attend postnatal care. Therefore, this study was done to identify factors associated with health facility delivery among mothers who attended four or more antenatal care visits. The study was also intended to identify factors associated with postnatal care service use among mothers who delivered at home after four or more antenatal care visits. Methods This study used the 2016 Ethiopian Demographic and Health Survey data. Two thousand four hundred fifteen women who attended four or more antenatal care visits were included to identify factors associated with health facility delivery after four or more antenatal care visits. Among them, 1055 mothers delivered at home. These women were included to identify factors associated with postnatal care service use. Stata 15.1 was used to analyze the data. Multivariable logistic regression model was fitted to identify associations between the outcome and predictor variables. Results Among women who had four or more antenatal care visits, 56% delivered at health facility. Mothers with secondary or higher level of education (AOR = 2.9; 95% CI = 1.6–5.3), urban residents (AOR = 3.4; 95% CI = 1.9–6.1), women with highest wealth quintile (AOR = 2.7; 95% CI = 1.5–4.8), and working women (AOR = 1.6; 95% CI = 1.2–2.3) had higher odds of delivering at health facilities. High birth order (AOR = 0.5; 95% CI = 0.3–0.7) was negatively associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Only the content of care received during antenatal care visits (AOR = 1.40; 95% CI = 1.1–1.8) was significantly associated with postnatal care attendance. Conclusion Women with lower socio-economic status had lower odds of giving birth at health facility even after attending antenatal care. The more antenatal care components a mother received, the higher her probability of delivering at health facility. Similarly, postnatal care attendance was higher among women who had received more antenatal care components.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,African Mental Health Research Initiative (AMARI) post-doctoral fellow, Addis Ababa University, Addis Ababa, Ethiopia
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11
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Fekadu GA, Kassa GM, Berhe AK, Muche AA, Katiso NA. The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:577. [PMID: 30041655 PMCID: PMC6056996 DOI: 10.1186/s12913-018-3370-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 07/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. Methods Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger’s test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). Result A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). Conclusion Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | | | | | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of public health, University of Gondar, Gondar, Ethiopia
| | - Nuradin Abusha Katiso
- Department of Nursing, College of Health Sciences and Medicine, Woliata Sodo University, Woliata Sodo, Ethiopia
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Abstract
: Objective: RNs are adopting an ever-larger role in health care models designed to reduce costs, increase patient satisfaction, and improve patient outcomes. Most research exploring such models has focused on those involving physicians or advanced practice nurses rather than RNs. This study explored the perspectives of patients, RNs, and other providers regarding a new prenatal connected care model for low-risk patients aimed at reducing in-office visits and creating virtual patient-RN connections. METHODS This qualitative evaluation was performed as part of a larger randomized controlled trial of the new care model. Individual interviews and asynchronous online focus groups were conducted with a total of 41 patients, up to 10 unit and connected care RNs, and up to 17 other providers (up to eight physicians and nine certified nurse midwives [CNMs]). RESULTS Thematic analysis indicated that patients in the new care model valued connectedness and relationships with the connected care RNs, including the ability to contact them as needed outside the office setting. Patients also valued their relationships with physicians and CNMs. Physicians appreciated having more time to care for higher-risk patients, and the connected care RNs appreciated being able to work to a fuller scope of practice, although participants in all provider groups suggested the increased use of protocols and other systems to ensure patient safety and improve communication among providers. CONCLUSIONS A prenatal connected care model for low-risk women allowed patients to decrease the number of scheduled in-person clinic visits with physicians or CNMs while building stronger nurse-patient relationships through virtual connected care visits with an RN. The results included increased patient satisfaction and greater autonomy for RNs, allowing them to work to a fuller scope of practice. Although the new model gave physicians more time in which to see higher-risk patients, CNM-patient relationships may have been limited.
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13
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A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum. Matern Child Health J 2017; 20:2217-2227. [PMID: 27663703 DOI: 10.1007/s10995-016-2187-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.
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Mitra M, Akobirshoev I, Moring NS, Long-Bellil L, Smeltzer SC, Smith LD, Iezzoni LI. Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey. J Womens Health (Larchmt) 2017; 26:1356-1363. [PMID: 28832265 DOI: 10.1089/jwh.2016.6297] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous qualitative studies suggest that women with physical disabilities face disability-specific barriers and challenges related to prenatal care accessibility and quality. This study aims to examine the pregnancy and prenatal care experiences and needs of U.S. mothers with physical disabilities and their perceptions of their interactions with their maternity care clinicians. MATERIALS AND METHODS We conducted the first survey of maternity care access and experiences of women with physical disabilities from 37 states. The survey was disseminated in partnership with disability community agencies and via social media and targeted U.S. women with a range of physical disabilities who had given birth in the past 10 years. The survey included questions regarding prenatal care quality and childbirth and labor experiences. RESULTS A total of 126 women with various physical disability types from 37 states completed the survey. Almost half of the respondents (53.2%) reported that their physical disability was a big factor in their selection of a maternity care provider and 40.3% of women reported that their prenatal care provider knew little or nothing about the impact of their physical disability on their pregnancy. Controlling for maternal demographic characteristics and use of mobility equipment, women who reported that their prenatal care provider lacked knowledge of disability and those who felt they were not given adequate information were more likely to report unmet needs for prenatal care. CONCLUSIONS The findings from this study suggest the need for training and education for clinicians regarding the prenatal care needs of women with physical disabilities.
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Affiliation(s)
- Monika Mitra
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Ilhom Akobirshoev
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Nechama Sammet Moring
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Linda Long-Bellil
- 2 Center for Health Policy and Research, University of Massachusetts Medical School , Shrewsbury, Massachusetts
| | - Suzanne C Smeltzer
- 3 Center for Nursing Research, Villanova University College of Nursing , Villanova, Pennsylvania
| | - Lauren D Smith
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Lisa I Iezzoni
- 4 Department of Medicine, Harvard Medical School, The Mongan Institute for Health Policy , Massachusetts General Hospital, Boston, Massachusetts
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Linard M, Blondel B, Estellat C, Deneux-Tharaux C, Luton D, Oury JF, Schmitz T, Mandelbrot L, Azria E. Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort. BJOG 2017. [DOI: 10.1111/1471-0528.14794] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Linard
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - B Blondel
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - C Estellat
- Epidemiology and Clinical Research Department; URC Paris-Nord; APHP; Paris France
- CIC 1425-EC; UMR 1123; INSERM; Paris France
| | - C Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - D Luton
- Department of Obstetrics and Gynaecology; Beaujon-Bichat Hospital; DHU Risks in Pregnancy; APHP; Paris Diderot University; Paris France
| | - JF Oury
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - T Schmitz
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology; Louis Mourier Hospital; DHU Risks in Pregnancy; AP-HP; Paris Diderot University; Colombes France
| | - E Azria
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
- Maternity Unit; Paris Saint Joseph Hospital; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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Bennett CT, Buchan JL, Letourneau N, Shanker SG, Fenwick A, Smith-Chant B, Gilmer C. A realist synthesis of social connectivity interventions during transition to parenthood: The value of relationships. Appl Nurs Res 2017; 34:12-23. [PMID: 28342618 DOI: 10.1016/j.apnr.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/31/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Lathrop B, Pritham UA. A pilot study of prenatal care visits blended group and individual for women with low income. Nurs Womens Health 2016; 18:462-74. [PMID: 25495967 DOI: 10.1111/1751-486x.12159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Healthy Pregnancy, Healthy Childbirth, Healthy Parenting (HPCP) is a blended prenatal care model that integrates group visits with individual prenatal visits. While group prenatal care has been found to have a positive impact on pregnancy outcomes, current models may not be feasible or desirable in all clinical settings. HPCP offers one educational group visit each trimester to improve knowledge of self-care during pregnancy and of childbirth and infant care. The program was piloted among women with low income in a southern metropolitan area. This article presents the findings of a pilot study that examined maternal knowledge acquisition and subsequent changes in self-efficacy and satisfaction with care. Suggestions for future use of a blended model for the delivery of prenatal care are shared.
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Debessai Y, Costanian C, Roy M, El-Sayed M, Tamim H. Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey. J Perinatol 2016; 36:420-6. [PMID: 26796126 DOI: 10.1038/jp.2015.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/23/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aims to investigate predictors of inadequate prenatal care (PNC) use among pregnant women in Canada. STUDY DESIGN Data for this secondary analysis was drawn from the Maternity Experiences Survey, a cross sectional, nationally representative survey that assessed peri- and post-natal experiences of mothers aged 15 and above in the Canadian provinces and territories. PNC use was measured by the Adequacy of Prenatal Care Utilization Index. Multivariate logistic regression analysis was conducted to determine socio-economic, demographic, maternal, delivery related and health service characteristics associated with inadequate PNC use. RESULTS Prevalence of inadequate PNC was at 18.9%. Regression analysis revealed that mothers who were immigrants (odds ratio (OR)=1.40; 95% (confidence interval) CI: 1.13-1.74), primiparous (OR=1.22; 95% CI: 1.04-1.44), smoked (OR=1.33; 95% CI: 1.04-1.69) or consumed alcohol (OR=1.32; 95% CI: 1.03-1.68) during their pregnancy were more likely to receive inadequate PNC. Mothers with a family doctor as PNC provider versus those with an obstetrician (OR=1.26; 95% CI: 1.08-1.48) were more likely to have inadequate PNC. CONCLUSIONS This is the first nationwide study in Canada to examine the factors associated with inadequate PNC use. Results of this study may help design interventions that target women with profiles of socio-demographic and behavioral risk to optimize their PNC use.
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Affiliation(s)
- Y Debessai
- School of Kinesiology and Health Science, Bethune College, York University, Toronto, ON, Canada
| | - C Costanian
- School of Kinesiology and Health Science, Bethune College, York University, Toronto, ON, Canada
| | - M Roy
- Department of Pediatrics, McMaster University, Hamilton ON, Canada
| | - M El-Sayed
- Department of Pediatrics, McMaster University, Hamilton ON, Canada
| | - H Tamim
- School of Kinesiology and Health Science, Bethune College, York University, Toronto, ON, Canada
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Tilden EL, Emeis CL, Caughey AB, Weinstein SR, Futernick SB, Lee CS. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission. J Midwifery Womens Health 2016; 61:427-34. [DOI: 10.1111/jmwh.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND AND PURPOSE To assess the psychometrics of the French language Quality of Prenatal Care Questionnaire (QPCQ). METHODS Data from 302 women were used in a confirmatory factor analysis and in assessment of construct validity through hypothesis testing and internal consistency reliability using Cronbach's alpha. RESULTS The 6 factors (subscales) were verified and confirmed. Hypothesis testing further supported construct validity. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = .97) as did 5 subscales (Cronbach's alpha = .70-.92); the Sufficient Time subscale had poorer reliability (Cronbach's alpha = .61). CONCLUSIONS The French language QPCQ is a valid and reliable self-report measure of prenatal care quality. It can be used in research and in quality improvement work to strengthen prenatal care services.
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Ridgeway JL, LeBlanc A, Branda M, Harms RW, Morris MA, Nesbitt K, Gostout BS, Barkey LM, Sobolewski SM, Brodrick E, Inselman J, Baron A, Sivly A, Baker M, Finnie D, Chaudhry R, Famuyide AO. Implementation of a new prenatal care model to reduce office visits and increase connectivity and continuity of care: protocol for a mixed-methods study. BMC Pregnancy Childbirth 2015; 15:323. [PMID: 26631000 PMCID: PMC4668747 DOI: 10.1186/s12884-015-0762-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Most low-risk pregnant women receive the standard model of prenatal care with frequent office visits. Research suggests that a reduced schedule of visits among low-risk women could be implemented without increasing adverse maternal or fetal outcomes, but patient satisfaction with these models varies. We aim to determine the effectiveness and feasibility of a new prenatal care model (OB Nest) that enhances a reduced visit model by adding virtual connections that improve continuity of care and patient-directed access to care. Methods and design This mixed-methods study uses a hybrid effectiveness-implementation design in a single center randomized controlled trial (RCT). Embedding process evaluation in an experimental design like an RCT allows researchers to answer both “Did it work?” and “How or why did it work (or not work)?” when studying complex interventions, as well as providing knowledge for translation into practice after the study. The RE-AIM framework was used to ensure attention to evaluating program components in terms of sustainable adoption and implementation. Low-risk patients recruited from the Obstetrics Division at Mayo Clinic (Rochester, MN) will be randomized to OB Nest or usual care. OB Nest patients will be assigned to a dedicated nursing team, scheduled for 8 pre-planned office visits with a physician or midwife and 6 telephone or online nurse visits (compared to 12 pre-planned physician or midwife office visits in the usual care group), and provided fetal heart rate and blood pressure home monitoring equipment and information on joining an online care community. Quantitative methods will include patient surveys and medical record abstraction. The primary quantitative outcome is patient-reported satisfaction. Other outcomes include fidelity to items on the American Congress of Obstetricians and Gynecologists standards of care list, health care utilization (e.g. numbers of antenatal office visits), and maternal and fetal outcomes (e.g. gestational age at delivery), as well as validated patient-reported measures of pregnancy-related stress and perceived quality of care. Quantitative analysis will be performed according to the intention to treat principle. Qualitative methods will include interviews and focus groups with providers, staff, and patients, and will explore satisfaction, intervention adoption, and implementation feasibility. We will use methods of qualitative thematic analysis at three stages. Mixed methods analysis will involve the use of qualitative data to lend insight to quantitative findings. Discussion This study will make important contributions to the literature on reduced visit models by evaluating a novel prenatal care model with components to increase patient connectedness (even with fewer pre-scheduled office visits), as demonstrated on a range of patient-important outcomes. The use of a hybrid effectiveness-implementation approach, as well as attention to patient and provider perspectives on program components and implementation, may uncover important information that can inform long-term feasibility and potentially speed future translation. Trial registration Trial registration identifier: NCT02082275 Submitted: March 6, 2014 Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0762-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Annie LeBlanc
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Megan Branda
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Roger W Harms
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Megan A Morris
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Kate Nesbitt
- Office of Risk Management, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Bobbie S Gostout
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Lenae M Barkey
- Practice Administration, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Susan M Sobolewski
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Ellen Brodrick
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Jonathan Inselman
- Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Anne Baron
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Angela Sivly
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Misty Baker
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Dawn Finnie
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Department of Health Sciences Research, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Rajeev Chaudhry
- Primary Care Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Center for Innovation, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Abimbola O Famuyide
- Obstetrics Division, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Weber Yorga KD, Sheeder JL. Which Pregnant Adolescents Would be Interested in Group-Based Care, and Why? J Pediatr Adolesc Gynecol 2015; 28:508-15. [PMID: 26164210 DOI: 10.1016/j.jpag.2015.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 01/30/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To determine if pregnant adolescents interested in group-based prenatal care have different demographic and psychosocial characteristics than those interested in individual prenatal care. Factors that influence the preferred model of prenatal care patients were assessed. DESIGN, SETTING, AND PARTICIPANTS Prospective comparison of demographic and psychosocial characteristics of 153 pregnant adolescents enrolled in an adolescent-oriented prenatal and pediatric program at Children's Hospital Colorado. INTERVENTIONS None. MAIN OUTCOME MEASURES Pregnant study participants were queried and their preferred mode of prenatal care and reasons for that preference were examined. RESULTS Younger (16 years and younger) and primiparous adolescents were more likely to be interested in group care. Those not interested in group-based care were more likely to smoke and wanted to be pregnant. Most participants were interested in group-based prenatal care to belong to a peer group, receive additional education and support, and to have fun. Reasons participants were not interested in group-based care included concerns about belonging to a group, preferring individual care, and experiencing logistical concerns such as scheduling conflicts, limited transportation, and childcare resources. CONCLUSIONS Identifying which patients are interested in group prenatal care influences development of the program model and recruiting procedures, maximizing the effectiveness of the program by offering services based on patient needs. Identifying factors that influence patients' prenatal care choices enables providers to offer support to reduce barriers to participation and structure care that is best suited to patients willing to commit to and engage in the program.
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Affiliation(s)
- Kim D Weber Yorga
- Prevention Research Center for Family and Child Health, University of Colorado School of Medicine, Aurora, Colorado.
| | - Jeanelle L Sheeder
- Prevention Research Center for Family and Child Health, University of Colorado School of Medicine, Aurora, Colorado; Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Pinzón-Rondón ÁM, Gutiérrez-Pinzon V, Madriñan-Navia H, Amin J, Aguilera-Otalvaro P, Hoyos-Martínez A. Low birth weight and prenatal care in Colombia: a cross-sectional study. BMC Pregnancy Childbirth 2015; 15:118. [PMID: 25989797 PMCID: PMC4491421 DOI: 10.1186/s12884-015-0541-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/24/2015] [Indexed: 12/13/2022] Open
Abstract
Background Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia. Methods Observational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done. Results A LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR = 0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR = 0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR = 1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW. Conclusion This research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics.
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Affiliation(s)
| | | | | | - Jennifer Amin
- Escuela de medicina y ciencias de la salud, Universidad del Rosario, Bogota, Colombia.
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Gheibizadeh M, Abedi HA, Mohammadi E, Abedi P. Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study. Nurs Ethics 2015; 23:465-77. [PMID: 25802210 DOI: 10.1177/0969733015573653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. OBJECTIVE This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. RESEARCH DESIGN In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. PARTICIPANTS AND RESEARCH CONTEXT A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. ETHICAL CONSIDERATIONS The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. FINDINGS Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. CONCLUSION The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women.
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Affiliation(s)
| | | | | | - Parvin Abedi
- Ahvaz Jundishapur University of Medical Sciences, Iran
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25
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Wilhelmova R, Hruba D, Vesela L. Key Determinants Influencing the Health Literacy of Pregnant Women in the Czech Republic. Zdr Varst 2014; 54:27-36. [PMID: 27646619 PMCID: PMC4820146 DOI: 10.1515/sjph-2015-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/14/2014] [Indexed: 12/17/2022] Open
Abstract
Background Health literacy is a critical determinant of women’s and children’s health and therefore has immense consequences for the health of society as well. Evidence from epidemiological, clinical and experimental studies indicates that unhealthy lifestyles and risky behavioural habits of parents before conception and during pregnancy influence the etiology of various health defects. Decreasing primary risk factors, practicing physical wellness, monitoring physiological markers and preparing for labour, breastfeeding and newborn care should be the main parental responsibilities during the prenatal period. Methods Our study focused on specifying the main determinants of health literacy among 360 pregnant Czech women by using an anonymous questionnaire and selected anthropometric data of mothers. The criteria for study participation produced a sample representing 1.41% of Czech women in labour during a given 2012 reference period. Results Despite quite adequate knowledge of both risks and supporting factors for pregnancy and foetal development, the lifestyles of a majority of the women surveyed were far from optimum: only 30% reported good dietary and physical activity habits, 24% were active or passive smokers and one third of the women occasionally drank alcohol, more often among those who were university educated. Conclusion Our results have confirmed previously published data noting that health literacy and a healthier lifestyle of pregnant women are associated with a higher level of education (except for alcohol drinking) and with contact with a midwife (in some examined parameters) in prenatal courses.
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Affiliation(s)
- Radka Wilhelmova
- Masaryk University, Faculty of Medicine, Department of Midwifery, Komenskeho nam. 2, 66243 Brno, Czech Republic; Masaryk University, Faculty of Medicine, Department of Preventive Medicine, Kamenice 5, 62500 Brno, Czech Republic
| | - Drahoslava Hruba
- Masaryk University, Faculty of Medicine, Department of Preventive Medicine, Kamenice 5, 62500 Brno, Czech Republic
| | - Lenka Vesela
- Masaryk University, Faculty of Medicine, Department of Midwifery, Komenskeho nam. 2, 66243 Brno, Czech Republic
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Kurtzman JH, Wasserman EB, Suter BJ, Glantz JC, Dozier AM. Measuring adequacy of prenatal care: does missing visit information matter? Birth 2014; 41:254-61. [PMID: 24750400 DOI: 10.1111/birt.12110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kotelchuck's Adequacy of Prenatal Care Utilization (APNCU) Index is frequently used to classify levels of prenatal care. In the Finger Lakes Region (FLR) of upstate New York, prenatal care visit information late in pregnancy is often not documented on the birth certificate. We studied the extent of this missing information and its impact on the validity of regional APNCU scores. METHODS We calculated the "weeks between" a mother's last prenatal care visit and her infant's date of birth. We adjusted the APNCU algorithm creating the Last Visit Adequacy of Prenatal Care (LV-APNC) Index using the last recorded prenatal care visit date as the end point of care and the expected number of visits at that time. We compared maternal characteristics by care level with each index, examining rates of reclassification and number of "weeks between" by birth hospital. Stuart-Maxwell, McNemar, chi-square, and t-tests were used to determine statistical significance. RESULTS Based on 58,462 births, the mean "weeks between" was 2.8 weeks. Compared with their APNCU Index score, 42.4 percent of mothers were reclassified using the LV-APNC Index. Major movement occurred from Intermediate (APNCU) to Adequate or Adequate Plus (LV-APNC) leaving the Intermediate Care group a more at-risk group of mothers. Those with Adequate or Adequate Plus Care (LV-APNC) increased by 31.6 percent, surpassing the Healthy People 2020 objective. CONCLUSIONS In the FLR, missing visit information at the end of pregnancy results in an underestimation of mothers' prenatal care. Future research is needed to determine the extent of this missing visit information on the national level.
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Affiliation(s)
- Jordan H Kurtzman
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Heaman MI, Sword WA, Akhtar-Danesh N, Bradford A, Tough S, Janssen PA, Young DC, Kingston DA, Hutton EK, Helewa ME. Quality of prenatal care questionnaire: instrument development and testing. BMC Pregnancy Childbirth 2014; 14:188. [PMID: 24894497 PMCID: PMC4074335 DOI: 10.1186/1471-2393-14-188] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/16/2014] [Indexed: 11/17/2022] Open
Abstract
Background Utilization indices exist to measure quantity of prenatal care, but currently there is no published instrument to assess quality of prenatal care. The purpose of this study was to develop and test a new instrument, the Quality of Prenatal Care Questionnaire (QPCQ). Methods Data for this instrument development study were collected in five Canadian cities. Items for the QPCQ were generated through interviews with 40 pregnant women and 40 health care providers and a review of prenatal care guidelines, followed by assessment of content validity and rating of importance of items. The preliminary 100-item QPCQ was administered to 422 postpartum women to conduct item reduction using exploratory factor analysis. The final 46-item version of the QPCQ was then administered to another 422 postpartum women to establish its construct validity, and internal consistency and test-retest reliability. Results Exploratory factor analysis reduced the QPCQ to 46 items, factored into 6 subscales, which subsequently were validated by confirmatory factor analysis. Construct validity was also demonstrated using a hypothesis testing approach; there was a significant positive association between women’s ratings of the quality of prenatal care and their satisfaction with care (r = 0.81). Convergent validity was demonstrated by a significant positive correlation (r = 0.63) between the “Support and Respect” subscale of the QPCQ and the “Respectfulness/Emotional Support” subscale of the Prenatal Interpersonal Processes of Care instrument. The overall QPCQ had acceptable internal consistency reliability (Cronbach’s alpha = 0.96), as did each of the subscales. The test-retest reliability result (Intra-class correlation coefficient = 0.88) indicated stability of the instrument on repeat administration approximately one week later. Temporal stability testing confirmed that women’s ratings of their quality of prenatal care did not change as a result of giving birth or between the early postpartum period and 4 to 6 weeks postpartum. Conclusion The QPCQ is a valid and reliable instrument that will be useful in future research as an outcome measure to compare quality of care across geographic regions, populations, and service delivery models, and to assess the relationship between quality of care and maternal and infant health outcomes.
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Affiliation(s)
- Maureen I Heaman
- College of Nursing and Departments of Community Health Sciences and Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg R3T 2N2, Manitoba, Canada.
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Zielinski R, Stork L, Deibel M, Kothari CL, Searing K. Improving Infant and Maternal Health through CenteringPregnancy: A Comparison of Maternal Health Indicators and Infant Outcomes between Women Receiving Group versus Traditional Prenatal Care. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojog.2014.49071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hall WA, Bandsmer JC, Gregg K, Ebbehoj C. Translating knowledge directly to childbearing women: a study of Canadian women's preferences. Health Care Women Int 2013; 34:363-79. [PMID: 23550948 DOI: 10.1080/07399332.2012.740109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Knowledge translation has relied on research products that take years to disseminate, losing relevance for intended users. We used a mixed-methods approach to determine women's preferences for research results and format, intention to share results, and potential benefits. We sampled healthy, pregnant women who completed survey data during their third trimesters and wanted access to results. Mothers preferred results about sleep, fears, and anxieties during later pregnancy to benefit from reassurance that their experiences were shared. Women mostly intended to share results with their social networks. Organizational contacts increased dissemination of the women's preferred information to nonstudy participants.
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Affiliation(s)
- Wendy A Hall
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
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Bauer J, Angus L, Fischler N, Rosenberg KD, Gipson TF, DeVoe JE. The impact of citizenship documentation requirements on access to medicaid for pregnant women in Oregon. Matern Child Health J 2011; 15:753-8. [PMID: 20602160 PMCID: PMC3397715 DOI: 10.1007/s10995-010-0632-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The federal Deficit Reduction Act of 2005 mandated citizenship documentation from all Medicaid applicants as a condition of eligibility and was implemented in Oregon on September 1, 2006. We assessed whether new citizenship documentation requirements were associated with delays in Medicaid authorization for newly pregnant eligible applicants during the first nine months of DRA implementation in Oregon. We conducted a pre-post analysis of administrative records to compare the length of time between Medicaid application and authorization for all newly pregnant, Medicaid-eligible applicants in Oregon (n = 29,284), nine months before and after September 1, 2006. We compared mean days from application to authorization (McNemar's), and proportion of eligible applicants who waited over 7, 30 and 45 days to be authorized (Pearson's coefficient). The mean number of days women waited for authorization increased from 18 days in the 9 months before DRA implementation to 22.6 days in the post-implementation 9 month period (P ≤ .001). The proportion of eligible applicants who waited 7, 30 and 45 days increased significantly following DRA implementation (P ≤ .001). The proportion of eligible applicants who were not authorized within the standard 45-day period increased from 6.9 to 12.5% following the DRA. Implementation of new citizenship documentation requirements was associated with significant delays in Medicaid authorization for eligible pregnant women in Oregon. Such delays in gaining insurance coverage can detrimentally affect access to early prenatal care initiation among a vulnerable population known to be at higher risk for certain preventable pregnancy-related complications.
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Affiliation(s)
- Joanna Bauer
- San Francisco Department of Public Health, 678 Church Street, San Francisco, CA 94114, USA,
| | - Lisa Angus
- Oregon Health Policy & Research, 1225 Ferry Street SE, 1st Floor, Salem, OR 97301, USA,
| | - Nurit Fischler
- Oregon Public Health Division, Office of Family Health, 800 NE Oregon Street, Suite 850, Portland, OR 97232, USA,
| | - Kenneth D. Rosenberg
- Oregon Public Health Division, Office of Family Health, 800 NE Oregon Street, Suite 850, Portland, OR 97232, USA,
| | - Teresa F. Gipson
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA,
| | - Jennifer E. DeVoe
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA,
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Women's experiences of group antenatal care in Australia—the CenteringPregnancy Pilot Study. Midwifery 2011; 27:138-45. [DOI: 10.1016/j.midw.2009.03.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/03/2009] [Accepted: 03/07/2009] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION A critical analysis of the CenteringPregnancy model of care research has not been conducted across studies. The aims of this project were to describe 1) the conceptual components of the CenteringPregnancy practice model, 2) the characteristics of the CenteringPregnancy literature, and 3) the research methods and outcomes across the CenteringPregnancy research literature. METHODS An integrative literature review methodology was used to assess the CenteringPregnancy literature published between 1994 and 2009. RESULTS The sample consisted of 26 articles (14 narrative descriptions, 10 quantitative studies, 1 mixed methods study, and 1 qualitative study) published predominantly in nursing and midwifery journals. The majority of quantitative studies were exploratory or quasi-experimental and longitudinal designs with the exception of 1 large, federally funded, randomized, controlled trial. Variables were individual and community level outcomes, which were not uniformly operationally defined or measured consistently across studies. Significant results for prenatal care attendance rates, adequate prenatal care, and breastfeeding rates were reported in a number of studies. Other results were often mixed or nonsignificant. DISCUSSION Positive outcomes for the CenteringPregnancy model have been suggested by research findings to date but require more systematic approaches to developing knowledge about the factors inherent in this model that promote participant behavior changes, which lead to better perinatal outcomes as well as circumstances that maximize the effectiveness of this model. Areas for improving the strength of the evidence are discussed. Building consistently demonstrated relationships across studies is essential for creating the evidence base on which practice decisions can be made. Further research is required for developing clarity and understanding about this model's effectiveness.
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Ayoola AB, Nettleman MD, Stommel M. Time from pregnancy recognition to prenatal care and associated newborn outcomes. J Obstet Gynecol Neonatal Nurs 2011; 39:550-6. [PMID: 20920001 DOI: 10.1111/j.1552-6909.2010.01167.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. DESIGN Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. SETTING Twenty-nine states. PARTICIPANTS Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. METHODS Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. RESULTS The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). CONCLUSION Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.
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Affiliation(s)
- Adejoke B Ayoola
- Department of Nursing, Calvin College, Grand Rapids, MI 49546, USA.
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Ustunsoz A, Senel N, Pollock CA. Comparison of prenatal education delivered by nurses in Ankara (Turkey) and New Orleans (USA). J Clin Nurs 2010; 20:1133-40. [PMID: 20955477 DOI: 10.1111/j.1365-2702.2010.03262.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This research was planned to compare prenatal education delivered by nurses in Ankara (Turkey) and New Orleans (USA). BACKGROUND Prenatal education can increase awareness and improve the knowledge about risks factors and complications of pregnant women. Therefore, prenatal education is an important determinant of improved health outcomes of infants and of reduced maternal mortality. DESIGN A descriptive survey. METHODS This descriptive study was performed in various obstetrics clinics and antenatal outpatient clinics between April 2002-April 2003. The sample included all graduate nurses in prenatal units who gave their informed consent to participate. A demographic data form to collect data and a prenatal education checklist were prepared by the investigator. RESULTS There was a significant difference in the educational levels of the nurses both in nursing education and in special courses as preparation to present prenatal education. The topics addressed during the prenatal education also differ significantly. The nurses in the USA mostly had a master's degree, while the nurses in Turkey mostly had two years of education after college. There was a significant difference between the two countries related to the qualification for giving prenatal education and having a certificate. CONCLUSION There was a significant difference between the educational preparation of presenting nurses as well as the content of prenatal education in Ankara, Turkey and New Orleans, USA. Turkish nurses may benefit from an educational programme to prepare them to present prenatal education that may improve the knowledge of pregnant women and eventually lead to reduced maternal and infant mortality. RELEVANCE TO CLINICAL PRACTICE The quality of the care provided by the nurses and midwives working in the prenatal area will increase following specific standardised training for becoming proficient.
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Affiliation(s)
- Ayfer Ustunsoz
- Gulhane Military Medical Academy School of Nursing, Ankara, Turkey.
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Schillaci MA, Waitzkin H, Carson EA, Romain SJ. Prenatal care utilization for mothers from low-income areas of New Mexico, 1989-1999. PLoS One 2010; 5:e12809. [PMID: 20862298 PMCID: PMC2941446 DOI: 10.1371/journal.pone.0012809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prenatal care is considered to be an important component of primary health care. Our study compared prenatal care utilization and rates of adverse birth outcomes for mothers from low- and higher-income areas of New Mexico between 1989 and 1999. METHODOLOGY/PRINCIPAL FINDINGS Prenatal care indicators included the number of prenatal care visits and the first month of prenatal care. Birth outcome indicators included low birth weight, premature birth, and births linked with death certificates. The results of our study indicated that mothers from low-income areas started their prenatal care significantly later in their pregnancies between 1989 and 1999, and had significantly fewer prenatal visits between 1989 and 1997. For the most part, there were not significant differences in birth outcome indicators between income groupings. CONCLUSIONS/SIGNIFICANCE These findings suggest that while mothers from low-income areas received lower levels of prenatal care, they did not experience a higher level of adverse birth outcomes.
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Affiliation(s)
- Michael A Schillaci
- Department of Social Sciences, University of Toronto Scarborough, Scarborough, Ontario, Canada.
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Hackley B, Applebaum J, Wilcox WC, Arevalo S. Impact of two scheduling systems on early enrollment in a group prenatal care program. J Midwifery Womens Health 2009; 54:168-75. [PMID: 19410208 DOI: 10.1016/j.jmwh.2009.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 10/20/2022]
Abstract
Group care is an effective approach to prenatal care. Yet difficulties in recruiting, enrolling, and scheduling women into group care present obstacles to optimal program delivery. The purpose of this study was to determine whether the use of a scheduling system based on women's estimated date of delivery (EDD) decreased gestational age at entry to group care, increased attendance, and improved continuity of care. A total of 13 groups were held; seven groups used a scheduling system based on appointment availability and six groups used a scheduling system based on women's EDD. Compared with the availability-based scheduling system, the EDD-based system decreased mean gestational age (23.2 vs. 21.8 weeks; P = .058) and significantly decreased mean maximum gestational age (31.0 vs. 26.3 weeks; P = .002) at entry to group care. The EDD-based system increased the mean number of sessions offered per group (6.7 vs. 8.2 sessions; P < .001); however, attendance rates were similar across systems. The EDD-based system also increased the percentage of women who had the same initial visit and group provider (78.0% vs. 85.5%; P = .303). The use of this system by other health care facilities could ease the task of enrolling a sufficient number of participants into group care, minimize the need for women to change care providers if they desire group care, and allow more time for educational activities and the development of social networks for women by offering more sessions per group.
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Affiliation(s)
- Barbara Hackley
- Women's Health Services, Montefiore South Bronx Health Center for Children and Families, Associate Professor, Yale University School of Nursing, Bronx, NY 10459, USA.
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Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in a public health clinic. J Midwifery Womens Health 2009; 54:27-34. [PMID: 19114236 DOI: 10.1016/j.jmwh.2008.05.008] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/26/2008] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
Abstract
CenteringPregnancy is a promising group visit prenatal care innovation that provides substantial health promotion content. Elements unique to group care include peer support and self-management training and activities. CenteringPregnancy was introduced at a large public health clinic serving predominantly low-income African American pregnant women. All prenatal care at this clinic was provided by certified nurse-midwives, and all providers were trained in the CenteringPregnancy model. One hundred and ten women received prenatal care in CenteringPregnancy groups. Focus groups of pregnant women, providers, and health center staff reported that the program benefited women despite implementation challenges such as scheduling changes. Compared to women in individual care, women in CenteringPregnancy had significantly more prenatal visits, increased weight gain, increased breast feeding rates, and higher overall satisfaction. This pilot project demonstrated that CenteringPregnancy can be implemented in a busy public health clinic serving predominantly low-income pregnant women and is associated with positive health outcomes.
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Affiliation(s)
- Carrie Klima
- University of Illinois at Chicago, Centering Pregnancy and Parenting Board of Directors, USA.
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Wheatley RR, Kelley MA, Peacock N, Delgado J. Women's narratives on quality in prenatal care: a multicultural perspective. QUALITATIVE HEALTH RESEARCH 2008; 18:1586-1598. [PMID: 18849519 DOI: 10.1177/1049732308324986] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Although significant progress has been made to increase prenatal care access, national organizations concerned with health equity emphasize that eliminating disparities will require greater attention to quality of care, assessed from both the biomedical and patient perspectives. In this study, we examined narratives about pregnancy experiences from low-income primiparous African American, Mexican American, Puerto Rican, and White women who participated in focus groups conducted in 1996. We reanalyzed transcripts from these discussions, extracting passages in which women talked about the content and quality of their prenatal care experiences. Data were mapped to four domains reflecting patient-centeredness markers identified in the 2005 U.S. National Healthcare Disparities Report (NHDR). These markers include the extent to which the women perceived that their provider listened carefully, explained things, showed respect, and spent enough time with them. The narratives provided by the study participants suggest a critical and intuitive understanding of the NHDR patient-centeredness markers and some shared understanding across cultural groups. Implications for improving quality and its measurement in prenatal care are discussed.
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Sunil TS, Spears WD, Hook L, Castillo J, Torres C. Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas. Matern Child Health J 2008; 14:133-40. [PMID: 18843529 DOI: 10.1007/s10995-008-0419-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
Abstract
Healthy People 2010 goals set a target of 90% of mothers starting prenatal care in the first trimester of pregnancy. While there are questions about the value of prenatal care (PNC), there is much observational evidence of the benefits of PNC including reduction in maternal, fetal, perinatal, and infant deaths. The objective of this study was to understand barriers to PNC as well as factors that impact early initiation of care among low-income women in San Antonio, Texas. A survey study was conducted among low-income women seeking care at selected public health clinics in San Antonio. Interviews were conducted with 444 women. Study results show that women with social barriers, those who were less educated, who were living alone (i.e. without an adult partner or spouse), or who had not planned their pregnancies were more likely to initiate PNC late in their pregnancies. It was also observed that women who enrolled in the WIC program were more likely to initiate PNC early in their pregnancies. Women who initiated PNC late in pregnancy had the highest odds of reporting service-related barriers to receiving care. However, financial and personal barriers created no significant obstacles to women initiating PNC. The majority of women in this study reported that they were aware of the importance of PNC, knew where to go for care during pregnancy, and were able to pay for care through financial assistance, yet some did not initiate early prenatal care. This clearly establishes that the decision making process regarding PNC is complex. It is important that programs consider the complexity of the decision-making process and the priorities women set during pregnancy in planning interventions, particularly those that target low-income women. This could increase the likelihood that these women will seek PNC early in their pregnancies.
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Affiliation(s)
- T S Sunil
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
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