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.
Introduction: Early and adequate prenatal care is important for patients to obtain health education, risk reduction, psychosocial support, and necessary medical interventions during the prenatal period. High-quality prenatal care encourages adequate care throughout pregnancy by increasing patients' desires to return for subsequent visits. This study aims to investigate the prenatal care experiences, desires, and needs of women in Florida. Methods: A mixed-methods study was conducted from April to December 2019 with postpartum women (n=55) who received no or late prenatal care and delivered in [City], Florida. Eligible women completed a survey and a semi-structured interview. The interview contextualized conditions shaping perceptions of the quality of prenatal care. Univariate analysis was conducted on the demographic characteristics and prenatal care locations. Qualitative analysis was performed using MAXQDA software and modified grounded theory. The analysis was based on Donabedian's quality of care model. Results: The participants self-identified as Hispanic (52%), White (48%), and Black (21%). Sixty-nine percent had Medicaid while 22% were self-pay. In the qualitative analysis, three core themes emerged. Clinical care processes included provision of health education and medical assessments. Structural conditions included language barriers, clinic availability, and ancillary staff presence. Lastly, interpersonal communication included impersonal care and multiple providers. The overarching conclusion from this analysis was the desire for patient-centered care. Participants wanted the care they received to be informative, tailored to their needs, and to work within the realities of their everyday lives. Discussion: Investigating women's experiences with seeking and receiving prenatal care are necessary to inform future interventions. Fostering a positive and patient-centered healthcare environment is necessary to improve the quality of care.
Background: This study examined employer experience with SARS-CoV-2 (COVID-19) asymptomatic testing through a social marketing lens. Social marketing uses commercial marketing principles to achieve socially beneficial ends including improved health and safety behavior. Method: Twenty employers across 11 occupational sectors were interviewed about implementation of COVID-19 testing from January through April 2021. Recorded transcripts were coded and analyzed using marketing’s “Four P’s”: “product,” “price,” “place,” “promotion.” Results: COVID-19 tests (product) were uncomfortable, were easily confused, and didn’t solve problems articulated by employers. Testing was not widely available or didn’t line up with shifts or locations (place). The perceived price, which included direct and associated costs (e.g., laboratory fees, productivity loss, logistical challenges) was high. Most crucially, the time to receive (PCR) results negated the major benefit of less time spent in quarantine and challenged employer trust. A potential audience segmentation strategy based on perceptions of exposure risk also emerged. Conclusions: This social marketing analysis suggests ways to improve the value proposition for asymptomatic testing through changes in product, price, and placement features in line with employers’ expressed needs. Study findings can also inform creation of employee communication materials that balance perceived rewards of testing against perceived risks of exposure.
During the first year of the COVID-19 pandemic, U.S. companies were seeking ways to support their employees to return to the workplace. Nonetheless, the development of strategies to support the access, use, and interpretation of SARS-CoV-2 testing was challenging. In the present study, we explore, from the perspective of owners and company leadership, the barriers to SARS-CoV-2 testing among U.S. companies. Key informant interviews with company representatives were conducted during January–April 2021 about SARS-CoV-2 testing. A pre-interview survey assessed respondent socio-demographic and organizational characteristics. Interview sessions were transcribed, coded, and analyzed using MaxQDA. A total of twenty interviews were completed with at least two interviews conducted in each major U.S. industry sector. Ninety percent of participants represented companies in business >10 years, comprising both small and large workforces. Using a grounded theory approach, six themes emerged: (1) access to and knowledge of SARS-CoV-2 tests; (2) strategies for symptomatic and asymptomatic testing of workers; (3) type/availability of personal protective equipment to mitigate coronavirus exposures; (4) return-to-work policies; (5) guidance and communication of SARS-CoV-2 Testing; and (6) use of contact tracing and SARS-CoV-2 vaccination. Various modifiable and non-modifiable challenges for SARS-CoV-2 testing among U.S. companies were identified and can inform work-related SARS-CoV-2 testing strategies.
Background and Objective: High-quality prenatal care promotes adequate care throughout pregnancy by increasing patients’ desires to return for follow-up visits. Almost 15% of women in the United States receive inadequate prenatal care, with 6% receiving late or no prenatal care. Only 63% of pregnant women in Florida receive adequate prenatal care, and little is known about their perceptions of high-quality prenatal care.Therefore, the objective of this study was to assess women’s perceptions of the quality of their prenatal care and to describe their preferences for seeking prenatal care that meets their needs. Methods: From April to December 2019, a qualitative study was conducted with postpartum women (n = 55) who received no or late prenatal care and delivered in Tampa, Florida, USA. Eligible women completed an open-ended qualitative survey and a semi-structured in-depth interview. The interview contextualized the factors influencing prenatal care quality perceptions.The qualitative data analysis was based on Donabedian’s quality of care model. Results: The qualitative data analysis revealed three key themes about women’s perceptions and preferences for prenatal care that meets their needs. First, clinical care processes included provision of health education and medical assessments. Second, structural conditions included language preferences, clinic availability, and the presence of ancillary staff. Finally, interpersonal communication encompassed interactions with providers and continuity of care. Overall, participants desired patient-centered care and care that was informative, tailored to their needs, and worked within the constraints of their daily lives. Conclusion and Global Health Implications: Women seeking and receiving prenatal care prefer a welcoming, patient-centered health care environment. These findings should prompt health care providers and organizations to improve existing prenatal care models and develop new prenatal care models that provide early, accessible, and high-quality prenatal care to a diverse population of maternity patients. Copyright © 2023 Fryer et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
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