Top

Published in:

01-12-2017

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Authors: Lee Anne Roman, Jennifer E. Raffo, Katherine Dertz, Bonita Agee, Denise Evans, Katherine Penninga, Tiffany Pierce, Belinda Cunningham, Peggy VanderMeulen

Published in: Maternal and Child Health Journal | Special Issue 1/2017

Abstract

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women’s health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

American Public Health Association Community Health Workers Sect. (2009). Community health workers. Retrieved from https://www.apha.org/apha-communities/member-sections/community-health-workers/.

Behrman, R. E., & Stith Butler, A. (2007). Preterm birth: Causes, consequences, and prevention. Washington, DC: The National Academies Press.

Bennett, I., Switzer, J., Aguirre, A., Evans, K., & Barg, F. (2006). ‘Breaking it down’: Patient-clinician communication and prenatal care among african american women of low and higher literacy. Annals of Family Medicine, 4(4), 334–340.CrossRefPubMedPubMedCentral

Borders, A. E., Wolfe, K., Qadir, S., Kim, K. Y., Holl, J., & Grobman, W. (2015). Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy. Journal of Perinatology, 35(8), 580–584.CrossRefPubMedPubMedCentral

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.CrossRef

Centers for Medicare & Medicaid Services. (2012). Strong start for mothers and newborns initiative: Enhanced. Retrieved from https://innovation.cms.gov/initiatives/strong-start-strategy-2/index.html.

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28(11), 1504–1510.CrossRefPubMedPubMedCentral

Cheng, T. L., Emmanuel, M. A., Levy, D. J., & Jenkins, R. R. (2015). Child health disparities: What can a clinician do? Pediatrics, 136(5), 961–968.CrossRefPubMedPubMedCentral

Clark, S. L., Belfort, M. A., Dildy, G. A., Englebright, J., Meints, L., Meyers, J. A., Frye, D. K., & Perlin, J. A. (2010). Emergency department use during the postpartum period: Implications for current management of the puerperium. American Journal of Obstetrics and Gynecology, 203(1), 38PubMed

Creanga, A. A., Bateman, B. T., Kuklina, E. V., & Callaghan, W. M. (2014a). Racial and ethnic disparities in severe maternal morbidity: A multistate analysis, 2008–2010. American Journal of Obstetrics and Gynecology, 210(5), 435.CrossRefPubMed

Creanga, A. A., Berg, C. J., Ko, J. Y., Farr, S. L., Tong, V. T., Bruce, F. C., & Callaghan, W. M. (2014b). Maternal mortality and morbidity in the united states: Where are we now? Journal of Women’s Health, 23(1), 3–9.CrossRefPubMedPubMedCentral

Dovidio, J. F., Penner, L. A., Albrecht, T. L., Norton, W. E., Gaertner, S. L., & Shelton, J. N. (2008). Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Social Science & Medicine, 67(3), 478–486.CrossRef

Gavin, A. R., Nurius, P., & Logan-Green, P. (2012). Mediators of adverse birth outcomes among socially disadvantaged women. Journal of Women’s Helath, 21(6), 634–641.CrossRef

Goodman, J. H., & Tyer-Viola, L. (2010). Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. Journal of Women’s Health, 19(3), 477–490.CrossRefPubMed

Grote, N. K., Zuckoff, A., Swartz, H., Bledsoe, S. E., & Geibel, S. (2007). Engaging women who are depressed and economically disadvantaged in mental health treatment. Social Work, 52(4), 295–308.CrossRefPubMedPubMedCentral

Hall, K. S., Kusunoki, Y., Gatny, H., & Barber, J. (2015). Social discrimination, stress, and risk of unintended pregnancy among young women. The Journal of Adolescent Health, 56(3), 330–337.CrossRefPubMedPubMedCentral

Hodgson, E. J., Collier, C., Hayes, L., Curry, L. A., & Fraenkel, L. (2013). Family planning and contraceptive decision-making by economically disadvantaged, african-american women. Contraception, 88(2), 289–296.CrossRefPubMed

Jennings, J., Nielsen, P., Buck, M. L., Collins-Fulea, C., Corry, M., Cutler, C., Faucher, M. A., Kendig, S., Kraft, C., McGinnity, J., Miller, K. P., Ralston, F. Jr., Rathfon, E., Webb, C., Wright, W., Daniel, H., Mastantuono, A., Lawrence, H. 3rd, Hawks, D., Hyde, M. A., Villalonga, M., Patterson, S. L., Emig, C., Guiliano, A., & K., O (2016). Executive summary: Collaboration in practice: Implementing team-based care: Report of the american college of obstetricians and gynecologists’ task force on collaborative practice. Obstetrics and Gynecology, 127(3), 612–617.CrossRefPubMed

Johnson, K. A., & Gee, R. E. (2015). Interpregnancy care. Seminars in Perinatology, 39(4), 310–315.CrossRefPubMed

Lu, M. C., Kotelchuck, M., Hogan, V. K., Johnson, K., & Reyes, C. (2010). Innovative strategies to reduce disparities in the quality of prenatal care in underresourced settings. Medical Care Research and Review, 67(5 Suppl), 198S–230S.CrossRefPubMed

Martin, A., Horowitz, C., Balbierz, A., & Howell, E. A. (2014). Views of women and clinicians on postpartum preparation and recovery. Maternal and Child Health Journal, 18(3), 707–713.CrossRefPubMedPubMedCentral

Meghea, C. I., Raffo, J. E., VanderMeulen, P., & Roman, L. A. (2014). Moving toward evidence-based federal healthy start program evaluations: Accounting for bias in birth outcomes studies. American Journal of Public Health, 104(Suppl 1), S25–S27.CrossRefPubMedPubMedCentral

Phillippi, J. C. (2009). Women’s perceptions of access to prenatal care in the united states: A literature review. Journal of Midwifery & Womens Health, 54(3), 219–225.CrossRef

Roman, L. A., Gardiner, J. C., Lindsay, J. K., Moore, J. S., Luo, Z., Baer, L. J., Goddeeris, J. H., Shoemaker, A. L., Barton, L. R., Fitzgerald, H. E., & Paneth, N. (2009). Alleviating perinatal depressive symptoms and stress: A nurse-community health worker randomized trial. Archives of Women’s Mental Health, 12(6), 379–391.CrossRefPubMed

Sacks, R. M., Greene, J., Burke, R., & Owen, E. C. (2015). Mental health care among low-income pregnant women with depressive symptoms: Facilitators and barriers to care access and the effectiveness of financial incentives for increasing care. Administration and Policy in Mental Health, 42(4), 484–492.CrossRefPubMed

Salm Ward, T. C., Mazul, M., Ngui, E. M., Bridgewater, F. D., & Harley, A. E. (2013). “You learn to go last”: Perceptions of prenatal care experiences among african-american women with limited incomes. Maternal and Child Health Journal, 17(10), 1753–1759.CrossRefPubMed

Slaughter-Acey, J. C., Caldwell, C. H., & Misra, D. P. (2013). The influence of personal and group racism on entry into prenatal care among african american women. Women’s health issues: official publication of the Jacobs Institute of Women’s Health, 23(6), e381–387.CrossRef

Slaughter-Acey, J. C., Sealy-Jefferson, S., Helmkamp, L., Caldwell, C. H., Osypuk, T. L., Platt, R. W., Straughen, J. K., Dailey-Okezie, R. K., Abeysekara, P., & Misra, D. P. (2016). Racism in the form of micro aggressions and the risk of preterm birth among black women. Annals of Epidemiology, 26(1), 7–13.CrossRefPubMed

Teagle, S. E., & Brindis, C. D. (1998). Perceptions of motivators and barriers to public prenatal care among first-time and follow-up adolescent patients and their providers. Maternal and Child Health Journal, 2(1), 15–24.CrossRefPubMed

Tschudy, M. M., Toomey, S. L., & Cheng, T. L. (2013). Merging systems: Integrating home visitation and the family-centered medical home. Pediatrics, 132(Supplement 2), S74–S81.CrossRefPubMedPubMedCentral

Verlinde, E., De Laender, N., De Maesschalck, S., Deveugele, M., & Willems, S. (2012). The social gradient in doctor-patient communication. International Journal for Equity in Health, 11, 12–12.CrossRefPubMedPubMedCentral

Yee, L. M., & Simon, M. A. (2014). The role of health literacy and numeracy in contraceptive decision-making for urban chicago women. Journal of Community Health, 39(2), 394–399.CrossRefPubMed

Title: Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement
Authors: Lee Anne Roman
Jennifer E. Raffo
Katherine Dertz
Bonita Agee
Denise Evans
Katherine Penninga
Tiffany Pierce
Belinda Cunningham
Peggy VanderMeulen
Publication date: 01-12-2017
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue Special Issue 1/2017
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-017-2372-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2017

Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative

Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team

First Trimester Prenatal Care Initiation Among Hispanic Women Along the U.S.-Mexico Border

Introduction to the Special Issue on Healthy Start

Voces de la frontera/Voices from the Border: Using Case Studies of Pregnancy, Birth and Parenting along the U.S.–Mexico Border to Identify Shared Measures of Success