Gina Novick

Is there a bias against telephone interviews in qualitative research

Telephone interviews are largely neglected in the qualitative research literature and, when discussed, they are often depicted as a less attractive alternative to face-to-face interviewing. The absence of visual cues via telephone is thought to result in loss of contextual and nonverbal data and to compromise rapport, probing, and interpretation of responses. Yet, telephones may allow respondents to feel relaxed and able to disclose sensitive information, and evidence is lacking that they produce lower quality data. This apparent bias against telephone interviews contrasts with a growing interest in electronic qualitative interviews. Research is needed comparing these modalities, and examining their impact on data quality and their use for studying varying topics and populations. Such studies could contribute evidence-based guidelines for optimizing interview data.

Women's Experience of Prenatal Care: An Integrative Review

The objective of this study was to identify, synthesize, and critically analyze published research on womens experiences of prenatal care. A search of online databases and relevant citations for research published from 1996 to 2007 was conducted. Thirty-six articles were reviewed. Qualitative analysis methods were used, assisted by research software. This review found that some women were treated respectfully and reported comprehensive, individualized care. However, some women experienced long waits and rushed visits, and perceived prenatal care as mechanistic or harsh. Womens preferences included reasonable waits, unhurried visits, continuity, flexibility, comprehensive care, meeting with other pregnant women in groups, developing meaningful relationships with professionals, and becoming more active participants in care. Some low-income and minority women experienced discrimination or stereotyping and external barriers to care. Further research is recommended to understand womens experiences and to develop and implement evidence-based, women-centered approaches. Clinicians should inquire regarding womens needs and modify care accordingly and also advocate for institutional changes that reduce barriers to care. Implementing comprehensive, redesigned models of care may be one effective way to simultaneously address a variety of womens needs and preferences. If prenatal care becomes more attractive and more accessible, womens experience and pregnancy outcomes may both improve.

Women’s Experience of Group Prenatal Care

Group prenatal care (GPNC) is an innovative alternative to individual prenatal care. In this longitudinal study we used ethnographic methods to explore African American and Hispanic women’s experiences of receiving GPNC in two urban clinics. Methods included individual, in-depth, semistructured interviews of women and group leaders in GPNC, participant observation of GPNC sessions, and medical record review. GPNC offered positive experiences and met many of women’s expressed preferences regarding prenatal care. Six themes were identified, which represented separate aspects of women’s experiences: investment, collaborative venture, a social gathering, relationships with boundaries, learning in the group, and changing self. Taken together, the themes conveyed the overall experience of GPNC. Women were especially enthusiastic about learning in groups, about their relationships with group leaders, and about having their pregnancy-related changes and fears normalized; however, there were also important boundaries on relationships between participants, and some women wished for greater privacy during physical examinations.

Group Prenatal Care: Model Fidelity and Outcomes

OBJECTIVE CenteringPregnancy group prenatal care has been demonstrated to improve pregnancy outcomes. However, there is likely variation in how the model is implemented in clinical practice, which may be associated with efficacy, and therefore variation, in outcomes. We examined the association of fidelity to process and content of the CenteringPregnancy group prenatal care model with outcomes previously shown to be affected in a clinical trial: preterm birth, adequacy of prenatal care, and breast-feeding initiation. STUDY DESIGN Participants were 519 women who received CenteringPregnancy group prenatal care. Process fidelity reflected how facilitative leaders were and how involved participants were in each session. Content fidelity reflected whether recommended content was discussed in each session. Fidelity was rated at each session by a trained researcher. Preterm birth and adequacy of care were abstracted from medical records. Participants self-reported breast-feeding initiation at 6 months postpartum. RESULTS Controlling for important clinical predictors, greater process fidelity was associated with significantly lower odds of both preterm birth (B = -0.43, Wald χ(2) = 8.65, P = .001) and intensive utilization of care (B = -0.29, Wald χ(2) = 3.91, P = .05). Greater content fidelity was associated with lower odds of intensive utilization of care (B = -0.03, Wald χ(2) = 9.31, P = .001). CONCLUSION Maintaining fidelity to facilitative group processes in CenteringPregnancy was associated with significant reductions in preterm birth and intensive utilization of care. Content fidelity also was associated with reductions in intensive utilization of care. Clinicians learning to facilitate group care should receive training in facilitative leadership, emphasizing the critical role that creating a participatory atmosphere can play in improving outcomes.

The Intersection of Everyday Life and Group Prenatal Care for Women in Two Urban Clinics

Women from vulnerable populations encounter challenging circumstances that generate stress and may adversely affect their health. Group prenatal care (GPNC) incorporates features that address social stressors, and has been demonstrated to improve pregnancy outcomes and prenatal care experiences. In this qualitative study, we describe the complex circumstances in the lives of women receiving care in two urban clinics and how GPNC attenuated them. Stressors included problems with transportation and child care, demanding jobs, poverty, homelessness, difficult relationships with partners, limited family support, and frustrating health care experiences. Receiving prenatal care in groups allowed women to strengthen relationships with significant others, gain social support, and develop meaningful relationships with group leaders. By eliminating waits and providing the opportunity to participate in care, GPNC also offered sanctuary from frustrations encountered in receiving individual care. Reducing such stressors may help improve pregnancy outcomes; however, more evidence is needed on mechanisms underlying these effects.

In a hard spot: providing group prenatal care in two urban clinics.

OBJECTIVES CenteringPregnancy (Centering) group prenatal care has been demonstrated to improve perinatal outcomes and provide a positive experience of care for women, but it can be difficult to implement and sustain in some clinical settings. The purpose of this study was to examine the challenges encountered when Centering group prenatal care was provided, and the responses of Centering group leaders to these challenges. DESIGN this was a longitudinal, qualitative study using interpretive description. Data collection included participant-observation and interviews with group leaders and women receiving group prenatal care. SETTING two urban clinics providing care to low income women in the northeastern United States. PARTICIPANTS interview participants were 23 pregnant women (primarily African-American and Hispanic) receiving group prenatal care; other participants were 24 significant others and support staff participating in groups, and two nurse-midwife group leaders. FINDINGS the clinics did not always provide full resources for implementing Centering as designed, creating numerous challenges for the group leaders, who were committed to providing group prenatal care. In an attempt to sustain the model in the face of these limitations, the group leaders made a number of compromises and modifications to the Centering model. KEY CONCLUSIONS the limited clinic resources and resulting modifications of the model had a number of downstream effects, some of which affected relationships within groups, participation, and group cohesion. IMPLICATIONS modifications of the Centering model should be undertaken with caution. Strategies are needed to enhance the success and sustainability of Centering in varied clinical settings so that the benefits of the model, which have been demonstrated under more controlled circumstances, can be conferred to women receiving routine care during pregnancy.

Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites

Group prenatal care improves perinatal outcomes, but implementing this complex model places substantial demands on settings designed for individual care. To describe perceived barriers and facilitators to implementing and sustaining CenteringPregnancy Plus (CP+) group prenatal care, 24 in-depth interviews were conducted with 22 clinicians, staff, administrators, and study personnel in six of the 14 sites of a randomized trial of the model. All sites served low-income, minority women. Sites for the present evaluation were selected for variation in location, study arm, and initial implementation response. Implementing CP+ was challenging in all sites, requiring substantial adaptations of clinical systems. All sites had barriers to meeting the models demands, but how sites responded to these barriers affected whether implementation thrived or struggled. Thriving sites had organizational cultures that supported innovation, champions who advocated for CP+, and staff who viewed logistical demands as manageable hurdles. Struggling sites had bureaucratic organizational structures and lacked buy-in and financial resources, and staff were overwhelmed by the models challenges. Findings suggested that implementing and sustaining health care innovation requires new practices and different ways of thinking, and health systems may not fully recognize the magnitude of change required. Consequently, evidence-based practices are modified or discontinued, and outcomes may differ from those in the original controlled studies. Before implementing new models of care, clinical settings should anticipate model demands and assess capacity for adapting to the disruptions of innovation.

Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: a systematic review.

Background While extensive research has explored pharmacokinetic interactions between antiretroviral therapy (ART) and hormonal contraception, few studies have examined whether these interactions affect clinical outcomes. To address this gap, we conducted a systematic review of the literature that describes hormonal contraceptive use among HIV-infected women who also use ART, focusing on papers that address clinically important outcomes such as pregnancy or ovulation. Methods/design An electronic literature search was conducted of PubMed and Ovid to identify all articles that addressed hormonal contraception co-administered with ART published in English between January 1, 1990 and October 30, 2014. In addition, manual reference checks of all articles of interest were conducted to identify articles not captured in the electronic search. Our search criteria identified 405 records. The title and abstract of data reports retrieved via the search were reviewed to identify potential articles of interest. Those with any indication of the main outcomes of interest were considered for inclusion (N=162). Abstracts were then reviewed to identify those manuscripts that would merit a review of the full-text version (N=64). Eight articles that addressed the outcomes of interest were identified. The Newcastle-Ottawa Scale was used to assess the quality of these articles. Results The studies reviewed were limited in a number of ways that precluded their providing a rigorous assessment of the efficacy of contraception when co-administered with ART. Discussion None of the studies were of adequate quality to provide the guidance that providers and HIV-infected women need when considering contraceptive options. High-quality, well-powered studies are required to address the efficacy of hormonal contraception when co-administered with ART.