Barriers to women's participation in inter-conceptional care: a cross-sectional analysis

BMC Public Health

Jennifer F Culhane¹  Diane Rowley³  Leny Mathews¹  David Webb¹  Althea D Anderson²  M Ahinee Amamoo³  Vijaya K Hogan⁴ 

[1] Children's Hospital of Philadelphia, Philadelphia, USA;Mailman School of Public Health, Columbia University, New York, NY, USA;Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Room 425 Rosenau, 421 Pittsboro Street, Chapel Hill, NC 27599, USA

关键词: Preconception care;    Utilization of care;    Access to care;    Preventive care;    Infant mortality;    Health care participation;    Perinatal periods of risk;    Pregnancy;    African American women;    Preterm birth;    Prematurity;   

Others  :  1163882
DOI  :  10.1186/1471-2458-12-93

 received in 2011-07-11, accepted in 2012-02-01,  发布年份 2012

【 摘 要 】

Background

We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.

Methods

A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.

Results

Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation.

Conclusions

Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.

【 授权许可】

   
2011 Hogan et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Callaghan W, MacDorman M, Rasmussen S, Qin C, Lackritz E: The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006, 118(4):1566.
• [2]MacDorman M, Callaghan W, Mathews T, Hoyert D, Kochanek K: Trends in preterm related infant mortality by race and ethnicity, United States, 1999-2004. Int J Health Serv 2007, 37(4):635-641.
• [3]MacDorman M, Mathews T: Recent trends in infant mortality in the United States. NCHS data brief 2008, 9:1-8.
• [4]CityMatCH: Perinatal Periods of Risk Approach. [http://www.citymatch.org/ppor_index.php] webcite
• [5]Besculides M, Laraque F: Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention. J Natl Med Assoc 2005, 97(8):1128.
• [6]Burns P: Reducing infant mortality rates using the perinatal periods of risk model. Public Health Nurs 2005, 22(1):2-7.
• [7]Cai J, Hoff G, Dew P, Guillory V, Manning J: Perinatal periods of risk: analysis of fetal-infant mortality rates in Kansas City, Missouri. Matern Child Health J 2005, 9(2):199-205.
• [8]DeClerque J, Freedman J, Verbiest S, Bondurant S: North Carolina's infant mortality problems persist: time for a paradigm shift. N C Med J 2004, 65(3):138-142.
• [9]Pestronk R, Franks M, Team R, Team H, Team P: A partnership to reduce African American infant mortality in Genesee County, Michigan. Public Health Rep 2003, 118(4):324.
• [10]Boulet S, Johnson K, Parker C, Posner S, Atrash H: A perspective of preconception health activities in the United States. Matern Child Health J 2006, 10:13-20.
• [11]Johnson K, Posner S, Biermann J, et al.: Recommendations to improve preconception health and health care--United States. Morb Mortal Wkly Rep 2006, 55:1-23.
• [12]Coonrod D, Jack B, Stubblefield P, et al.: The clinical content of preconception care: infectious diseases in preconception care. Am J Obstet Gynecol 2008, 199(6):S296-S309.
• [13]Daniels P, Noe G, Mayberry R: Barriers to prenatal care among Black women of low socioeconomic status. Am J Health Behav 2006, 30(2):188-198.
• [14]Andersen R: Revisiting the behavioral model and access to medical care: does it matter? J health Soc Behav 1995, 36(1):1-10.
• [15]Webb D, Coyne J, Goldenberg R, et al.: Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project. BMC Med Res Methodol 2010, 10(1):88. BioMed Central Full Text
• [16]Stokes ME, Davis CS, Koch GG: 2000 Categorical Data Analysis Using the SAS® System. Second edition. Cary: SAS Institute Inc;
• [17]SAS 9.2 [computer program]. Cary, NC, USA; 2008.
• [18]Gelberg L, Browner CH, Lejano E, Arangua L: Access to women's health: a qualitative study of barriers perceived by homeless women. Women & Health 2004, 40(2):87-100.
• [19]Melnikow J, Alemagno S: Adequacy of prenatal care among inner-city women. J Fam Pract 1993, 37(6):575.
• [20]Johnson A, El-Khorazaty M, Hatcher B, et al.: Determinants of late prenatal care initiation by African American women in Washington, DC. Matern Child Health J 2003, 7(2):103-114.
• [21]Mikhail B, Curry M: Perceived impediments to prenatal care among low-income women. West J Nurs Res 1999, 21(3):335.
• [22]York R, Grant C, Tulman L, Rothman R, Chalk L, Perlman D: The impact of personal problems on accessing prenatal care in low-income urban African American women. J Perinatol 1999, 19(1):53.
• [23]Milligan R, Wingrove B, Richards L, et al.: Perceptions about prenatal care: views of urban vulnerable groups. BMC Public Health 2002, 2(1):25. BioMed Central Full Text
• [24]Mikhail B: Prenatal care utilization among low-income African American women. J Community Health Nurs 2000, 17(4):235-246.
• [25]Stein J, Andersen R, Gelberg L: Applying the Gelberg-Andersen behavioral model for vulnerable populations to health services utilization in homeless women. J Health Psychol 2007, 12(5):791.
• [26]Sword W: A socio-ecological approach to understanding barriers to prenatal care for women of low income. J Adv Nurs 1999, 29(5):1170-1177.
• [27]Lu M, Kotelchuck M, Hogan V, Johnson K, Reyes C: Innovative Strategies to Reduce Disparities in the Quality of Prenatal Care in Underresourced Settings. Med Care Res Rev 2010, 67:198S.