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Reid CN, Fryer K, Cabral N, Marshall J. Health care system barriers and facilitators to early prenatal care among diverse women in Florida. Birth 2021; 48:416-427. [PMID: 33950567 DOI: 10.1111/birt.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Worldwide, women continue to experience barriers to accessing early prenatal care. Given the unique nature of the United States health care system, this study aimed to identify barriers and facilitators to early prenatal care reported by women in Florida. METHODS A mixed-methods study of postpartum women with entry to care after 14 weeks' gestation was conducted at a tertiary care hospital in Florida. First, eligible women completed a survey including demographic characteristics and open-ended questions on prenatal care barriers. Second, a semi-structured interview was conducted to contextualize the conditions of access. The qualitative analysis was based on the combined theoretical frameworks of Phillippi and Khan. RESULTS The majority of the 55 participants self-identified as Hispanic (n = 28, 51%), non-Hispanic White (n = 12, 22%), or non-Hispanic Black (n = 9, 16%). Quantitative analysis identified frequent barriers, including the following: "couldn't get an appointment when wanted one" (n = 24, 47%); "didn't have insurance" (n = 21, 41%); and "not aware of pregnancy" (n = 21, 41%). From the combined quantitative and qualitative analyses, three major themes emerged that help to explain barriers faced by birthing people in Florida: personal factors (mental health, awareness of pregnancy, considering abortion, tumultuous life), community conditions (transportation, stigma/fear, social support), and health care system (language barriers, delay at clinic level, cost of care). DISCUSSION Barriers to early prenatal care are multifaceted and operate at personal, societal, and health care systems levels. Prenatal care practitioners have multiple potential targets for interventions at the clinic level to help mitigate barriers to early prenatal care. Strategies should include health care policy reforms to Medicaid access and interventions at the clinic level aimed at fast-tracking access to care.
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Affiliation(s)
- Chinyere N Reid
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kimberly Fryer
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Naciely Cabral
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jennifer Marshall
- Chiles Center, Sunshine Education and Research Center, University of South Florida College of Public Health, Tampa, FL, USA
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Reproductive-Age Women's Experience of Accessing Treatment for Opioid Use Disorder: "We Don't Do That Here". Womens Health Issues 2021; 31:455-461. [PMID: 34090780 DOI: 10.1016/j.whi.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE For reproductive-age women, medications for opioid use disorder (OUD) decrease risk of overdose death and improve outcomes but are underutilized. Our objective was to provide a qualitative description of reproductive-age women's experiences of seeking an appointment for medications for OUD. METHODS Trained female callers placed telephone calls to a representative sample of publicly listed opioid treatment clinics and buprenorphine providers in Florida, Kentucky, Massachusetts, Michigan, Missouri, North Carolina, Tennessee, Virginia, Washington, and West Virginia to obtain appointments to receive medication for OUD. Callers were randomly assigned to be pregnant or non-pregnant and have private or Medicaid-based insurance to assess differences in the experiences of access by these characteristics. The callers placed 28,651 uniquely randomized calls, 10,117 to buprenorphine-waivered prescribers and 754 to opioid treatment programs. Open-ended, qualitative data were obtained from the callers about the access experiences and were analyzed using a qualitative, iterative inductive-deductive approach. From all 28,651 total calls, there were 17,970 unique free-text comments to the question "Please give an objective play-by-play of the description of what happened in this conversation." FINDINGS Analysis demonstrated a common path to obtaining an appointment. Callers frequently experienced long hold times, multiple transfers, and difficult interactions. Clinic receptionists were often mentioned as facilitating or obstructing access. Pregnant callers and those with Medicaid noted more barriers. Obtaining an appointment was commonly difficult even for these persistent, trained callers. CONCLUSIONS Interventions are needed to improve the experiences of reproductive-age women as they enter care for OUD, especially for pregnant women and those with Medicaid coverage.
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Fryer K, Lewis G, Munoz C, Stuebe AM. Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women. N C Med J 2021; 82:7-13. [PMID: 33397748 PMCID: PMC7927271 DOI: 10.18043/ncm.82.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.
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Affiliation(s)
- Kimberly Fryer
- assistant professor, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida.
| | - Ginny Lewis
- program manager, Expanding Networks for Latinos through Community Engagement, The North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris Munoz
- associate professor, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison M Stuebe
- professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Fryer K, Delgado A, Foti T, Reid CN, Marshall J. Implementation of Obstetric Telehealth During COVID-19 and Beyond. Matern Child Health J 2020; 24:1104-1110. [PMID: 32564248 PMCID: PMC7305486 DOI: 10.1007/s10995-020-02967-7] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth. DESCRIPTION The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations-including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing. ASSESSMENT The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care. CONCLUSION Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.
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Affiliation(s)
- Kimberly Fryer
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA.
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA
| | - Tara Foti
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Chinyere N Reid
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jennifer Marshall
- Sunshine Education and Research Center, Chiles Center College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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'They Forget I'm Deaf': Exploring the Experience and Perception of Deaf Pregnant Women Attending Antenatal Clinics/Care. Ann Glob Health 2020; 86:96. [PMID: 32832389 PMCID: PMC7413196 DOI: 10.5334/aogh.2942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Antenatal care (ANC) services provide access to integrated health management for several pregnancy related conditions. Unfortunately, deaf pregnant women remain vulnerable during pregnancy due to lack of access as well as communication barriers at antenatal clinics in Nigeria. Objective: The primary aim of this study was to explore the experiences and satisfaction of pregnant deaf women with antenatal care in Nigeria. Methods: This was a qualitative study, conducted among nine deaf pregnant women from two local government areas, attending both private and public health facilities for antenatal care in Ibadan, Oyo State, Nigeria. Data were collected using semi-structured, video recorded one-on-one interviews, with sign language as the medium of communication. The interviews were conducted until saturation of the themes was reached. The recorded interviews were precisely transcribed and thematic analyses were conducted on the data obtained. Findings: The mean age of the participants was 29.5 years. Participants indicated that they had registered/booked for antenatal care in their second trimester. Registration at this stage was regarded as late registration of the pregnancies. Communication difficulties during their ANC (antenatal care) visits, distance and location of the clinics, knowledge and perception of what ANC entailed, finance/cost, and health care professionals’ attitudes towards the participants were the major themes identified for late ANC bookings. Participants who attended privately owned health care facilities for ANC had more satisfaction with ANC care than those attending publicly owned health facilities. Conclusions: Deaf pregnant women were knowledgeable about ANC but registered late for the service, largely due to communication difficulties, distance to the clinic, cost, and the perceived attitudes of the health care workers. There existed a variance in the level of satisfaction of deaf pregnant women who attended private or public health facilities.
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Fryer K, Munoz MC, Rahangdale L, Stuebe AM. Multiparous Black and Latinx Women Face More Barriers to Prenatal Care than White Women. J Racial Ethn Health Disparities 2020; 8:80-87. [PMID: 32333378 DOI: 10.1007/s40615-020-00759-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Women who are late to prenatal care miss opportunities for health interventions and are at increased risk for pregnancy-related complications. Black women have the lowest rates of first trimester care compared with White or Latinx women. We sought to describe barriers to prenatal care experienced by race/ethnicity in a multi-site, prospective cohort. STUDY DESIGN We performed a secondary analysis of the Community Child Health Research Network Study, a multi-site prospective cohort study of pregnant women from 2008 to 2012. Women were recruited at the time of delivery and followed prospectively for 2 years. Participants who experienced a repeat pregnancy in the 2-year follow-up period had a prospective assessment of prenatal care barriers. A multilevel mixed effects Poisson regression was performed to evaluate the association between race/ethnicity and number of prenatal barriers. RESULTS Of the 298 participants in the sample, 43% of Black, 35% of Latinx, and 23% of White participants reported barriers to prenatal care. After adjustment for confounders, Black and Latinx women reported almost twice as many barriers to prenatal care as White women (adjusted rate ratio 1.89 [1.2, 3.0]; 2.00 [1.1, 3.8], respectively). CONCLUSION In our analysis, multiparous Black and Latinx women reported encountering more barriers to prenatal care than White women. Additional reforms and policy change are needed at the clinic, local, and state levels to support women in accessing early quality prenatal care to achieve racial equity in prenatal care.
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Affiliation(s)
- Kimberly Fryer
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
| | - Maria Christina Munoz
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Leandro TA, Nunes MM, Teixeira IX, Lopes MVDO, Araújo TLD, Lima FET, Silva VMD. Development of middle-range theories in nursing. Rev Bras Enferm 2020; 73:e20170893. [DOI: 10.1590/0034-7167-2017-0893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify in the literature how Middle-Range Theories (MRT) are being developed in Nursing. Method: Integrative review on the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed portal, using the keywords middle range theory and nursing, as well its Portuguese correspondents (Lilacs), and the Boolean operator AND. The sample included 25 articles. Results: All articles presented concepts related to MRT. Most developed a synthesis picture. Some theories have formulated specific propositions, hypotheses, and names. Only 16 articles cited the methodological framework, while 22 used theories or models for theoretical foundation and 11 carried out literature reviews. Final considerations: The development of MRT included the presentation of fundamental concepts, synthesis, propositions, hypotheses and specific name. The MRT is recognized as a way of developing knowledge to guide the nursing practice.
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Abstract
The purpose of this article is to present an analysis on the theory development strategies that have been used to develop middle-range theories through an integrated literature review and to provide directions for future theoretical development in nursing. First, theory development strategies that have been suggested and used in nursing are briefly discussed. Second, the methods used for the analysis are described. Then, 4 themes reflecting the theory development strategies that have been used to develop middle-range theories are discussed. Finally, suggestions for future theoretical development in nursing are made on the basis of the findings.
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Mayrink J, Souza RT, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, Calderon IM, Sousa MH, Costa ML, Baker PN, Cecatti JG. Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study. Sci Rep 2019; 9:9517. [PMID: 31266984 PMCID: PMC6606578 DOI: 10.1038/s41598-019-46011-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022] Open
Abstract
The objective of this study is to determine the incidence, socio-demographic and clinical risk factors for preeclampsia and associated maternal and perinatal adverse outcomes. This is a nested case-control derived from the multicentre cohort study Preterm SAMBA, in five different centres in Brazil, with nulliparous healthy pregnant women. Clinical data were prospectively collected, and risk factors were assessed comparatively between PE cases and controls using risk ratio (RR) (95% CI) plus multivariate analysis. Complete data were available for 1,165 participants. The incidence of preeclampsia was 7.5%. Body mass index determined at the first medical visit and diastolic blood pressure over 75 mmHg at 20 weeks of gestation were independently associated with the occurrence of preeclampsia. Women with preeclampsia sustained a higher incidence of adverse maternal outcomes, including C-section (3.5 fold), preterm birth below 34 weeks of gestation (3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls. They also had worse perinatal outcomes, including lower birthweight (a mean 379 g lower), small for gestational age babies (RR 2.45 [1.52-3.95]), 5-minute Apgar score less than 7 (RR 2.11 [1.03-4.29]), NICU admission (RR 3.34 [1.61-6.9]) and Neonatal Near Miss (3.65 [1.78-7.49]). Weight gain rate per week, obesity and diastolic blood pressure equal to or higher than 75 mmHg at 20 weeks of gestation were shown to be associated with preeclampsia. Preeclampsia also led to a higher number of C-sections and prolonged hospital admission, in addition to worse neonatal outcomes.
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Affiliation(s)
- Jussara Mayrink
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Francisco E Feitosa
- MEAC - Maternity School of the Federal University of Ceará, Fortaleza, CE, Brazil
| | - Edilberto A Rocha Filho
- Department of Maternal and Child Health, Maternity Hospital, Federal University of Pernambuco, Recife, PE, Brazil
| | - Débora F Leite
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil.,Department of Maternal and Child Health, Maternity Hospital, Federal University of Pernambuco, Recife, PE, Brazil
| | - Janete Vettorazzi
- Department of Obstetrics and Gynaecology, Maternity Hospital, Federal University of RS, Porto Alegre, RS, Brazil
| | - Iracema M Calderon
- Department of Obstetrics and Gynaecology, Botucatu School of Medicine, Unesp, Botucatu, SP, Brazil
| | - Maria H Sousa
- Statistics Unit, Jundiai School of Medicine, Jundiaí, SP, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Philip N Baker
- College of Life Sciences, Maurice Shock Building, University of Leicester, Leicester, UK
| | - Jose G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil.
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Phillippi JC, Holley SL, Payne K, Schorn MN, Karp SM. Facilitators of prenatal care in an exemplar urban clinic. Women Birth 2016; 29:160-7. [DOI: 10.1016/j.wombi.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/03/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
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Danhausen K, Joshi D, Quirk S, Miller R, Fowler M, Schorn MN. Facilitating Access to Prenatal Care Through an Interprofessional Student-Run Free Clinic. J Midwifery Womens Health 2015; 60:267-273. [DOI: 10.1111/jmwh.12304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Phillippi JC, Myers CR, Schorn MN. Facilitators of prenatal care access in rural Appalachia. Women Birth 2014; 27:e28-35. [DOI: 10.1016/j.wombi.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/20/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
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