Betty Lia-Hoagberg

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the womens perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mothers beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.

Assessment, program planning, and evaluation in population-based public health practice.

Public health practitioners in Minnesota developed and implemented a population-based public health practice model for community assessment, program planning, and evaluation. The ultimate goal of this process is improvement in population health. Major challenges to the implementation of a population-based model are addressed through the use of a theory of action; interventions at community, systems, and individual levels; and intermediate evaluation indicators. Examples of resulting changes in public health practice are described.

Prenatal care use and health insurance status.

Many observers explain the prevalence of inadequate prenatal care in the United States by citing demographic or psychosocial factors. But few have evaluated the barriers faced by women with different health insurance status and socioeconomic backgrounds. In this study of 149 women at six hospitals in Minneapolis, insurance status was significantly related to the source of prenatal care (p<.0001). Private physicians cared for 52 percent of privately insured, 23 percent of Medicaid-insured, and two percent of uninsured women. Public clinics were the primary source of care for Medicaid and uninsured women, who, compared to privately insured women, experienced longer waiting times (p<.001) during prenatal visits and were more likely (p<.01) to lack continuity of care with a provider. Multiple measures, including expanding Medicaid eligibility, may help correct these problems.

Evidenced-based guidelines for public health nursing practice

Abstract Practice guidelines that provide research-based information for practice and promote improved health outcomes are needed in public health nursing. The Minnesota Practice Enhancement Project describes the development process, instrument, and dissemination of guidelines to practicing nurses.

The Meaning of Family Health Among Mexican American First-Time Mothers and Fathers

An ethnographic approach was used to obtain knowledge from the perspective of Mexican American first-time parents about the meaning of family health stated in their own words. The study was conducted in the Sullivan Division of Hidalgo County, Texas. Twenty-six families were followed longitudinally with a mean of eight (SD = 1.8) home visits per family. Audio-taped conversations with mothers and fathers in either English or Spanish were transcribed verbatim as recorded. The participants’ expressed meaning of family health emphasized family unity with joint parenting. Couples used a variety of metaphors to convey what family unity meant to them.

Community interdisciplinary education to promote partnerships in family violence prevention

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month postevaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.

Medicaid and non-medicaid prenatal care by nurse-midwives Comparison of risk, time, care coordination, and reimbursement

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance payment (HRPI) on use of provider time, care coordination activities, and financial reimbursement. Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care providers in giving antepartum, intrapartum, and postpartum care was highest for the HRPI women. However, the two medical assistance groups started prenatal care significantly later and had fewer visits, and one-third did not return for their 6-weeks postpartum visit. The HRPI group also had a higher cesarean birth rate. Rates of care coordination activities such as calls, referrals, and consultations were significantly higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximately 73% of the total amount billed was collected compared with approximately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.

Fulfilling Regional Needs for Specialty Nurses through Limited-cohort Graduate Education

The University of Minnesota has developed a limited-cohort distance education graduate program to overcome geographic barriers and address the shortage of masters-prepared specialty nurses in rural areas of the upper Midwest. Such a program offers graduate nursing education in various specialty areas to distance sites for a predetermined, relatively short period.

Prenatal Care among Low-Income Women

Forty low-income pregnant women were interviewed about the personal, family, and provider rewards and costs they experienced in obtaining prenatal care. The women identified important rewards as the health of their babies, their own health, partners desire for a healthy baby, monitoring of the pregnancy by qualified healthcare personnel, and the evaluation of problems by health-care providers. The authors suggest strategies to strengthen personal, family, and provider rewards aimed at achieving a high level of prenatal care for low-income women.

A Computerized Information System

By providing comprehensive data on patient care and outcomes, these new systems help promote better health services and efficient program evaluation.