Top

Published in:

27-06-2023 | Prenatal Care

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest

Authors: Juliana Teruel Camargo, Romina L. Barral, Elizabeth H. Kerling, Lillian Saavedra, Susan E. Carlson, Byron J. Gajewski, Mariana Ramírez

Published in: Maternal and Child Health Journal | Issue 10/2023

Abstract

Background

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts.

Objectives

This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community.

Methods

This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area.

Results

FTPNC was challenged by women’s immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education.

Conclusions for Practice

Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

Atkins, L., Francis, J., Islam, R., et al. (2017). A guide to using the theoretical domains Framework of behavior change to investigate implementation problems. Implementation Science, 12, 1–18.CrossRef

Baer, R. J., Altman, M. R., Oltma, S. P., et al. (2019). Maternal factors influencing late entry into prenatal care: A stratified analysis by race or ethnicity and insurance status. Journal of Maternal-Fetal & Neonatal Medicine, 32(20), 3336–3342. https://doi.org/10.1080/14767058.2018.1463366.CrossRef

Bediako, P. T., BeLue, R., & Hillemeier, M. M. (2015). A comparison of birth outcomes among black, hispanic, and black hispanic women. Journal of racial and ethnic health disparities, 2(4), 573–582. https://doi.org/10.1007/s40615-015-0110-2.CrossRefPubMedPubMedCentral

Bonnevie, E., Rosenberg, S. D., Goldbarg, J., et al. (2021). Building strong futures: The feasibility of using a targeted Digital Media Campaign to improve knowledge about pregnancy and low Birthweight among Black Women. Maternal and child health journal, 9. https://doi.org/10.1007/s10995-020-03068-1.

Brown, S. S. (1988). Barriers to the Use of Prenatal Care. In Prenatal Care: Reaching Mothers, Reaching Infants: National Academies Press (US). https://doi.org/10.17226/731

Capps, R., & Soto, R., AG (2019). Health Insurance Coverage for Immigrants and Latinos in the Kansas City Metro Area. Washington, DC: Migration Policy Institute.

Caraveo, C. A., Basurto, L. E., Gonzalez, D., & Pan, C. (2021). Barriers to Medicaid and CHIP Coverage for Eligible but Uninsured Latinx Children: A Texas Case Study. Washington DC: Urban Institute.

Centers for Disease Control and Prevention (CDC) (2000). Measuring healthy days: population assessment of health-related quality of life. Atlanta, Georgia: US Department of Health and Human Services.

Centers for Disease Control and Prevention (CDC) (2015). PRAMS model surveillance protocol. https://www.cdc.gov/prams/methodology.htm (accessed 16 July 2021).

Cervantes, R. C., Fisher, D. G., Padilla, A. M., et al. (2016). The hispanic stress Inventory Version 2: Improving the assessment of acculturation stress. Psychological Assessment, 28(5), 509. https://doi.org/10.1037/pas0000200.CrossRefPubMed

Cunningham, S. D., Riis, V., Line, L., et al. (2020). Safe Start Community Health Worker Program: A Multisector Partnership to improve perinatal outcomes among low-income pregnant women with Chronic Health Conditions. American Journal of Public Health, 110(6), 836–839. https://doi.org/10.2105/ajph.2020.305630.CrossRefPubMedPubMedCentral

Department of Health and Human Services (2017). Coverage for lawfully present immigrants. https://www.healthcare.gov/immigrants/lawfully-present-immigrants/ (accessed 5 April 2023).

Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health affairs, 26(5), 1258–1268. https://doi.org/10.1377/hlthaff.26.5.1258.CrossRefPubMed

Docherty, A., & Johnston, A. L. (2015). Prenatal care in Oregon and Washington: Policy and utilization for vulnerable women. Nur Res, 64(2), 117–127. https://doi.org/10.1097/NNR.0000000000000073.CrossRef

Evans, N. M., & Sheu, J. J. (2019). Validating a path model of adherence to prenatal care recommendations among pregnant women. Patient Education and Counseling, 102(7), 1350–1356. https://doi.org/10.1016/j.pec.2019.02.028.CrossRefPubMed

Gómez, S., & O’Leary, A. O. (2019). On Edge all the Time”: Mixed-status households navigating Health Care Post Arizona’s most stringent anti-immigration Law. Frontiers in public health, 6, 383.CrossRefPubMedPubMedCentral

Heaman, M., Bayrampour, H., Kingston, D., et al. (2013). Migrant women’s utilization of prenatal care: A systematic review. Maternal and child health journal, 17(5), 816–836.CrossRefPubMed

Heetkamp, K. M., Peters, I. A., Bertens, L. C. M., et al. (2020). An unwanted pregnancy and language proficiency level are associated with first antenatal visit after the first trimester: Results from a prospective cohort study. Midwifery, 89, 6. https://doi.org/10.1016/j.midw.2020.102784.CrossRef

Hefele, J. G., Santos, P., Ritter, G., et al. (2018). Risk factors for shoulder dystocia: The impact of Mother’s race and ethnicity. Journal of racial and ethnic health disparities, 5(2), 333–341. https://doi.org/10.1007/s40615-017-0374-9.CrossRefPubMed

Hennink, M. M., Kaiser, B. N., & Weber, M. B. (2019). What influences saturation? Estimating sample sizes in Focus Group Research. Qualitative Health Research, 29(10), 1483–1496.CrossRefPubMedPubMedCentral

Hoff, T. J., Pohl, H., & Bartfield, J. (2004). Creating a learning environment to produce competent residents: The roles of culture and context. Academic Medicine, 79(6), 532–539. https://doi.org/10.1097/00001888-200406000-00007.CrossRefPubMed

Howell, E. A., Egorova, N. N., Janevic, T., et al. (2017). Severe maternal morbidity among hispanic women in New York City: Investigation of health disparities. Obstetrics and gynecology, 129(2), 285. https://doi.org/10.1097/aog.0000000000001864.CrossRefPubMed

Johnson, K. M., & Lichter, D. T. (2016). Diverging demography: Hispanic and non-hispanic contributions to US population redistribution and diversity. Population Research and Policy Review, 35(5), 705–725. https://doi.org/10.1007/s11113-016-9403-3.CrossRef

Justman, N., Shahak, G., Gutzeit, O., et al. (2020). Lockdown with a price: The impact of the COVID-19 pandemic on prenatal care and perinatal outcomes in a Tertiary Care Center. Irs Med Assoc J, 22(9), 533–537.

Krikorian Atkinson, M., Benneyan, J. C., Phillips, R. S., Schiff, G. D., Hunt, L. S., & Singer, S. J. (2021). Patient engagement in system redesign teams: A process of social identity. Journal Of Health Organization And Management, 26, https://doi.org/10.1108/JHOM-02-2021-0064.

Lee, S. Y. D., Stucky, B. D., Lee, J. Y., et al. (2010). Short assessment of health literacy—spanish and english: A comparable test of health literacy for spanish and english speakers. Health services research, 45(4), 1105–1120. https://doi.org/10.1111/j.1475-6773.2010.01119.x.CrossRefPubMedPubMedCentral

Lindsay, A. C., de Oliveira, M. G., Wallington, S. F., et al. (2016). Access and utilization of healthcare services in Massachusetts, United States: A qualitative study of the perspectives and experiences of brazilian-born immigrant women. Bmc Health Services Research, 16. https://doi.org/10.1186/s12913-016-1723-9.

Lomelino Pinheiro, R., Areia, A. L., Mota Pinto, A., & Donato, H. (2019). Advanced maternal age: Adverse outcomes of pregnancy, a Meta-analysis. Acta Medica Portuguesa, 32(3), 219–226. https://doi.org/10.20344/amp.11057.CrossRef

Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of psychosomatic research 2005; 58(2), 163–171. https://doi.org/10.1016/j.jpsychores.2004.09.006

Marin, G., Sabogal, F., Marin, B. V., et al. (1987). Development of a short acculturation scale for Hispanics. Hispanic journal of behavioral sciences, 9(2), 183–205. https://doi.org/10.1177%2F07399863870092005CrossRef

Mathews, T., & Hamilton, B. E. (2017). Total fertility rates by state and race and Hispanic origin: United States. Available at: https://stacks.cdc.gov/view/cdc/61878. (accessed 30 August 2021).

Michie, S., Johnston, M., Abraham, C., et al. (2005). Making psychological theory useful for implementing evidence based practice: A consensus approach. BMJ Quality & Safety, 14, 26–33.CrossRef

National Academy for State Health Policy (2008). Health outcomes and lower costs associated with Medicaid family planning waivers. https://www.nashp.org/wp-content/uploads/sites/default/files/shpbriefing_familyplanningoutcomes.pdf (accessed 16 July 2021).

Noah, A. J. (2017). Immigrant enclaves and inadequate prenatal care among mexican-origin mothers. American Journal Of Health Behavior, 41(5), 642–651. f.CrossRefPubMed

Onwuegbuzie, A. J., & Leech, N. L. (2007). Sampling designs in qualitative research: Making the sampling process more public. Qualitative Report, 12(2), 238–254.

Osterman, M. J. K., & Martin, J. A. (2016). Timing and adequacy of prenatal care in the United States. National Vital Statistics Reports : From The Centers For Disease Control And Prevention, National Center For Health Statistics, National Vital Statistics System, 67(3), 1–14. https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_03.pdf (accessed 30 August 2021).

Pacheco Young, A. M., Catalano, R., & Gemmill, A. (2022). The 2016 presidential election and prenatal care utilization among Foreign-born hispanic pregnant people. Medical Care, 60(11), 799–805. https://doi.org/10.1097/MLR.0000000000001753.CrossRef

Passel, J. S., Lopez, M. H., & Chon, D. V. (2022). U.S. Hispanic population continued its geographic spread in the 2010s. Hispanic/Latino Demographics. Pew Research Center, https://www.pewresearch.org/fact-tank/2022/02/03/u-s-hispanic-population-continued-its-geographic-spread-in-the-2010s/ (accessed 30 June 2022).

Perreira, K. M., & Pedroza, J. M. (2019). Policies of Exclusion: Implications for the Health of Immigrants and Their Children. In J. E. Fielding (Ed.), Annual Review of Public Health, 40: 147–166. https://doi.org/10.1146/annurev-publhealth-040218-044115

Rhodes, S. D., Mann, L., Siman, F. M., et al. (2015). The impact of local Immigration Enforcement Policies on the health of immigrant Hispanics/Latinos in the United States. American Journal of Public Health, 105(2), 329–337. https://doi.org/10.2105/ajph.2014.302218.CrossRefPubMedPubMedCentral

Rodriguez, M. I., Swartz, J. J., Lawrence, D., et al. (2020). Extending Delivery Coverage to include prenatal care for Low-Income, immigrant women is a cost-effective strategy. Womens Health Issues, 30(4), 240–247. https://doi.org/10.1016/j.whi.2020.02.004.CrossRefPubMed

Selchau, K., Babuca, M., Bower, K., et al. (2017). First trimester prenatal care initiation among hispanic women along the U.S.-Mexico Border. Maternal And Child Health Journal, 21(Suppl 1), 11–18. https://doi.org/10.1007/s10995-017-2374-0.CrossRefPubMedPubMedCentral

Swartz, J. J., Hainmueller, J., Lawrence, D., et al. (2017). Expanding prenatal care to unauthorized immigrant women and the effects on infant health. Obstetrics and gynecology, 130(5), 938. https://doi.org/10.1097/aog.0000000000002275.CrossRefPubMed

Symon, G. E., & Cassell, C. E. (1998). Qualitative methods and analysis in organizational research: A practical guide. Sage Publications Ltd.

US Department of Health and Human Services. Eunice Kennedy Shriver National Institute of Child Health and Human Development. What is prenatal care and why is it important? https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care#:~text=Prenatal%20visits%20to%20a%20health,tests%2 C%20such%20as%20ultrasound%20exams. Published: 1/31/2017. Accessed: 03/23/2023.

World Health Organization (WHO) (2003). Reproductive Health, & World Health Organization. Department of Reproductive Health. Pregnancy, childbirth, postpartum, and newborn care: a guide for essential practice World Health Organization 2003.

World Health Organization (WHO) (2015). State of inequality: reproductive maternal newborn and child health: interactive visualization of health data: World Health Organization 2015, https://www.who.int/docs/default-source/gho-documents/health-equity/state-of-inequality/state-of-inequality-reproductive-maternal-new-born-and-child-health.pdf?sfvrsn=f4034289_2 (accessed 30 August 2021).

Zack, M. M., & Centers for Disease Control and Prevention (CDC). (2013). Health-related quality of life—United States, 2006 and 2010. MMWR Surveill Summ, 62(Suppl 3), 105–101. https://www.cdc.gov/mmwr/pdf/other/su6203.pdf?utm_source=baytoday.ca&utm_campaign=baytoday.ca&utm_medium=referral#page=107 (accessed 30 August 2021).

Title: Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest
Authors: Juliana Teruel Camargo
Romina L. Barral
Elizabeth H. Kerling
Lillian Saavedra
Susan E. Carlson
Byron J. Gajewski
Mariana Ramírez
Publication date: 27-06-2023
Publisher: Springer US
Keywords: Prenatal Care
Gestational Diabetes
Gestational Diabetes
Published in: Maternal and Child Health Journal / Issue 10/2023
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-023-03733-1

At a glance: The STEP trials

Springer Medicine

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest

Abstract

Background

Objectives

Methods

Results

Conclusions for Practice

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions for Practice

Please log in to get access to this content

Other articles of this Issue 10/2023

Respectful Maternity Care Practices During Normal Delivery at the Public Health Facilities in Tamil Nadu, Southern India: A Descriptive Study

The Determinants of Utilisation of Herbal Medicine Among Pregnant Women in the Asante Akim North District, Ghana

Explaining the Link Between Paternal Socioeconomic Position and Small for Gestational Age Birth: The Effect of Maternal Unhealthy Behaviors

Examining Black Women’s Breastfeeding Experiences in the United States: A Scoping Review of Qualitative Studies

Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis

Risk Factors of Preterm Delivery in the Lao PDR: Hospital-Based Matched Case–Control Study