This study utilized the qualitative methodology of focus groups to explore health care needs and perceived barriers to obtaining health care for urban and rural women and children in areas served by nurse practitioner (NP) and certified nurse midwife (CNM) clinics. The clinics operate in a southeastern county with a rural health professional shortage area designation, and an urban ZIP code area with high rates of infant mortality and serious pediatric conditions. The aim of the study was to delineate barriers to health care in order to develop appropriate services at the clinics and to improve access. Four focus groups with a total of 31 women from the communities were convened. Content analysis shows that access to the clinics is hampered by the community women's limited knowledge of CNMs and NPs and their specific roles in providing health care services. The women suggested that clinics counter their low profile by a more vigorous outreach promotion.

Purpose (1) Mother‐infant interaction is crucial for optimal infant development and parenting. In the environment of prenatal substance use/abuse there is potential for both mother and child to present negative interactive behaviors. Recent increased incidence of substance use/abuse by pregnant women in the United States has provoked concern for the infant's outcome in these circumstances. Recent literature does not indicate uniformly dismal outlook for infants born exposed to drugs. In this paper, published research from the 1990s that specifically addressed the relationship between prenatal substance use/abuse and the mother‐infant interaction was examined utilizing the Barnard model of parent‐infant interaction as a guide. Twenty‐three articles matched search criteria and were included in the review. Conclusions (2) The majority of studies (14/23) showed that maternal substance abuse was associated with a recognizably detrimental impact on mother‐child interaction. Six studies did not confirm an adverse effect. Negative impact on the interaction was related to the degree of maternal substance abuse in three studies and to its continuation postnatally in two. Postnatal environment correlated strongly with the quality of mother‐child interaction in the substance‐exposed dyads. Implications (3) Clinical and research implications are described.

This comparative study evaluated mother-child interaction in southeastern U.S. mother-child dyads where the mother was HIV positive and determined if the presence of maternal HIV infection was associated with differences in the quality of the mother-child interaction. A comparison was made between two groups of mother-child dyads, one where the mother was HIV positive (N = 25) and one where the mother was not HIV positive (N = 25). The Barnard model of mother-infant interaction guided this study. The quality of interaction within the dyads was assessed using the Nursing Child Assessment Teaching Scales (NCATS). Associated maternal, child, and environmental factors were described using an interview form, Centers for Epidemiologic Studies Depression Scale, and the Bayley Infant Neurodevelopmental Screener. The quality of mother-child interaction in the two groups was compared using chi square and paired t tests. Findings from this research showed no statistically significant difference in mother-child interaction (measured by NCATS) between the HIV-positive and HIV-negative groups. Although maternal symptoms of depression were noted in more of the HIV-positive mothers, covariant analysis failed to show this factor had any significant influence on mother-child interaction scores between the groups. It was noted that total sample (N = 50) group mean scores on NCATS maternal subscale and total interaction were significantly lower than published population norms. As the mother-child interaction has critical implications for the child, strategies to improve reciprocity need to be developed in this population, and attention must be paid to mental health needs of HIV-positive women.

This study utilized the qualitative methodology of focus groups to explore health care needs and perceived barriers to obtaining health care for urban and rural women and children in areas served by nurse practitioner (NP) and certified nurse midwife (CNM) clinics. The clinics operate in a southeastern county with a rural health professional shortage area designation, and an urban ZIP code area with high rates of infant mortality and serious pediatric conditions. The aim of the study was to delineate barriers to health care in order to develop appropriate services at the clinics and to improve access. Four focus groups with a total of 31 women from the communities were convened. Content analysis shows that access to the clinics is hampered by the community women's limited knowledge of CNMs and NPs and their specific roles in providing health care services. The women suggested that clinics counter their low profile by a more vigorous outreach promotion.

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