Understanding Women’s Awareness and Access to Preconception Health Care in a Rural Population: A Cross Sectional Study

Despite evidence of the benefits of preconception health care (PCHC), little is known about awareness and access to PCHC for rural, reproductive-aged women. This study aimed to assess the prevalence of PCHC conversations between rural reproductive-age women and health care providers, PCHC interventions received in the past year, and ascertain predictors of PCHC conversations and interventions. Women (n?=?868; 18–45 years) completed a questionnaire including reproductive history, health care services utilization, and interest in PCHC. The prevalence of health care providers’ PCHC conversations was 53.9?%, and the mean number of interventions reported was 2.6?±?2.7 (±SD). Significant predictors of PCHC conversation based on adjusted odds ratios from logistic regression were race (Native American 76?% greater than White), health care provider type (non-physician 63?% greater than physician), visits to a health care provider (3+ times 32?% greater than 1–2 times), and pregnancy planning (considering in next 1–5 years 51?% greater than no plans). Significant predictors of PCHC interventions received in the past 12 months based on adjusted risk ratios from negative binomial regression were race (Native American 22?% greater than White), PCHC conversation with a health care provider (yes 52?% lower than no), reporting PCHC as beneficial (yes 32?% greater than don’t know), and visits to a health care provider in the past year (3+ times 90?% greater than 1–2 times). Increasing conversations about PCHC between health care providers and their reproductive-aged patients can improve awareness and increase their likelihood of receiving all of the recommended interventions.     

‘A Normal Delivery Takes Place at Home’: A Qualitative Study of the Location of Childbirth in Rural Ethiopia

To identify reasons why women who access health facilities and utilise maternal newborn and child health services at other times, do not necessarily deliver at health facilities. Forty-six semi-structured interviews were conducted with mothers who had recently delivered (n = 30) or were pregnant (n = 16). Thematic analysis of the interview data resulted in emerging trends that were critically addressed according to the research objective. Of the 30 delivered cases, 14 had given birth at a health facility, but only 3 of those had planned to do so. The remaining 11 had attended due to long or complicated labours. Five dominant themes influencing location of delivery were identified: perceptions of a normal delivery; motivations encouraging health facility delivery; deterrents preventing health facility deliveries; decision-making processes; and level of knowledge and health education. Understanding the socio-cultural determinants that influence the location of delivery has implications for service provision. Alongside timely health education and maximising the contact between women and healthcare professionals, these determinants should be actively incorporated into maternal newborn and child health policy and programming in ways that encourage the utilisation of health facilities, even for routine deliveries.     

Women’s Autonomy in Infant Feeding Decision-Making: A Qualitative Study in Nairobi,Kenya

Maternal and Child Health Journal - Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that women living with HIV on antiretroviral therapy should EBF for...     

Low-Income Women’s Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study

Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the “one size fits most” approach. Lastly, mothers reported relying on their “instincts” and that “all babies are different” when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother–child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.     

Women’s Experience and Understanding of Food Cravings in Pregnancy: A Qualitative Study in Women Receiving Prenatal Care at the University of North Carolina–Chapel Hill

BackgroundAlthough the occurrence of food cravings during pregnancy is well established, there is a paucity of qualitative data on pregnant women’s perceptions of and responses to food cravings. This study sought to assess and describe pregnant women’s experiences and behaviors pertaining to food cravings.MethodsEight focus groups were conducted with 68 pregnant women in their second trimester from March 2015 to October 2016. Using a semistructured approach, the facilitator asked women open-ended questions regarding their experience of eating behaviors and food cravings. The content from the focus groups was analyzed using a bottom-up approach based on grounded theory and constant comparison analysis.ResultsParticipants described cravings as urgent, food-specific, and cognitively demanding occurrences that were differentiated from hunger. They described beliefs surrounding the physiological causes of cravings and rationales for satisfying their cravings. Strategies used to manage cravings included environmental modifications to limit proximity and availability of craved foods, cognitive and behavioral strategies like distraction, and acceptance through satisfying the craving. Participants described food cravings as a psychologically salient aspect of their pregnancy, reporting a variety of emotional precursors and reactions surrounding their cravings.ConclusionsA better understanding of food cravings may assist with the development of interventions to improve eating behaviors and reduce eating-related distress during pregnancy. Acceptance regarding food cravings was indicated as a way to diffuse pregnancy-related stress. These findings contribute to our understanding of psychological influences on eating behaviors in pregnant women.     

Does the Quality of Prenatal Care Matter in Promoting Skilled Institutional Delivery? A Study in Rural Mexico

Objectives: To determine if the quality of prenatal care predicts skilled institutional delivery, a primary means of reducing maternal mortality. Methods: The probability of skilled institutional delivery is predicted among 4173 rural low-income women of reproductive age in seven Mexican states, as a function of maternal retrospective reports about prenatal care services received in 1997–2003. Results: Women who received most prenatal care procedures were more likely to have a skilled institutional delivery (OR 2.29, 95% CI 1.18, 4.44). Women who received less than the 75th percentile of prenatal care procedures were not significantly different from those who received no prenatal care. Conclusions: Policies promoting increased access to prenatal services should be linked to the promotion of practice standards to impact health and behavioral outcomes.National Institute of Public Health, Avenue Universidad No. 655     

Property Rights Violations as a Structural Driver of Women’s HIV Risks: A Qualitative Study in Nyanza and Western Provinces, Kenya

While access to and control over assets can minimize women’s HIV risk, little is known about the processes through which property rights violations increase the sexual transmission of HIV. The current study focused on two rural areas in Nyanza and Western Province, Kenya where HIV prevalence was high (23.8–33 %) and property rights violations were common. The current work drew on in-depth interview data collected from 50 individuals involved in the development and implementation of a community-led land and property rights program. The program was designed to respond to property rights violations, prevent disinheritance and asset stripping, and reduce HIV risk among women. In our findings, we detailed the social and economic mechanisms through which a loss of property rights was perceived to influence primary and secondary prevention of HIV. These included: loss of income, loss of livelihood and shelter, and migration to slums, markets, or beaches where the exchange of sex for food, money, shelter, clothing, or other goods was common. We also examined the perceived influence of cultural practices, such as wife inheritance, on HIV risk. In the conclusions, we made recommendations for future research in the science-base focused on the development of property ownership as a structural HIV prevention and treatment intervention.     

Women’s Private Conversations about Abortion: A Qualitative Study

Abortion is a relatively frequent experience, yet public discourse about abortion is contentious and stigmatizing. Little literature is available on private conversations about abortion, which may be distinct from public discourse. We explored private discourse by documenting the nature of women’s discussions about abortion with peers in a book club. We recruited thirteen women’s book clubs in nine states. Participants (n = 119) read the book Choice: True Stories of Birth, Contraception, Infertility, Adoption, Single Parenthood, & Abortion, and participated in a book club meeting, which we audio-recorded and transcribed. Data collection occurred between April 2012 and April 2013. In contrast to public discourse of abortion, private discourse was nuanced and included disclosures of multiple kinds of experiences with abortion. Participants disclosed having abortions, considering abortion as an option for past or future pregnancies, and supporting others through an abortion. Distinguishing between public and private discourse enabled us to identify that an “abortion experience” could include personal decisions, hypothetical decisions, or connection with someone having an abortion. The book club atmosphere provided a rare opportunity for participants to explore their relationship to abortion. More research is needed to understand the role of private discourse in reducing abortion stigma.     

Women’s Perceptions of Usefulness and Ease of Use of Four Healthy Eating Blog Characteristics: A Qualitative Study of 33 French-Canadian Women

Background

Healthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices.

Factors Affecting Latina Immigrants’ Perceptions of Maternal Health Care: Findings From a Qualitative Study

Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants’ experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.     

Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

Maternal and Child Health Journal - Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in...     

Vulnerable Women’s Perceptions of Individual Versus Group Prenatal Care: Results of a Cross-Sectional Survey

Introduction Vulnerable pregnant women (e.g. women with low socio-economic status or recent immigrants) are less likely to receive adequate prenatal care or to attend perinatal education classes. CenteringPregnancy (CP) is a model of group prenatal care which combines assessment, education and support. This study aimed to assess patient experience among vulnerable women in group prenatal care compared to individual care. Methods Women participating in CP at a community-based health centre in urban Alberta were eligible to participate. A convenience sample of women who received individual care at a low-risk maternity clinic served as comparison. Women were asked a series of questions on their prenatal care experience. Demographic and patient responses were compared using Chi square, fisher’s exact and t tests. Results Forty-five women accessing CP and 92 women accessing individual care participated. Women in CP were younger, more likely to be single and having their first baby than women in individual care. Women in CP were significantly more likely to report having received enough information on exercise during pregnancy (92 vs. 66%, p?=?0.002), breastfeeding (95 vs. 70%, p?=?0.002) and baby care (95 vs. 67%, p?=?0.001). Women in CP were more likely to report that they felt their prenatal care providers were interested in how the pregnancy was affecting their life (100 vs. 93%, p?≤?0.001). Discussion Group prenatal care provides a positive experience and improved information exchange among vulnerable populations. Programs interested in engaging, educating and empowering vulnerable pregnant women may benefit from implementation of group care.     

Influences on Parents’ Child Care Choices: A Comparative Analysis of Preschool and Long Day Care Users

Background

This paper investigates Australian parents’ child care decision-making, including the motivational and influential factors that they attribute to their choice. Research demonstrates that child care decision making is multifaceted, involving a combination of child-related, personal, familial and contextual considerations. Existing research has tended to compare centre-based child care users with those using family-based options, and has not examined differences in the decision-making of parents who using different centre-based options.

Objective

This study compared the characteristics and child care choices of parents using long day care (LDC) with those using preschool services to determine (1) whether they differ demographically and (2) if their reported child care decision-making motivations and influences diverge.

Method

Participants were 1418 parents who completed a nationally-distributed survey in which they provided demographic information, specified their reasons for choosing to use child care, and rated the importance of factors that influenced their child care choice.

Results

LDC parents had, on average, younger children, worked longer hours and resided in areas with lower socioeconomic resources than preschool parents. When compared with preschool parents, those using LDC were more likely to nominate pragmatic factors as influencing their child care decision making. External pressures, mainly related to educational outcomes, were more salient for preschool than LDC parents. However, both groups of parents similarly rated child-centred factors as the most important overall influence.

Conclusion

Our findings add complexity to current understandings of parents’ child care decision making by showing that parents should not be treated as a homogenous group by policy makers, providers, and researchers.

     

Migrant Women’s Utilization of Prenatal Care: A Systematic Review

Our objectives were to determine whether migrant women in Western industrialized countries have higher odds of inadequate prenatal care (PNC) compared to receiving-country women and to summarize factors that are associated with inadequate PNC among migrant women in these countries. We conducted searches of electronic databases (MEDLINE, EMBASE, and PsycINFO), reference lists, known experts, and an existing database of the Reproductive Outcomes And Migration international research collaboration for articles published between January, 1995 and April, 2010. Title and abstract review and quality appraisal were conducted independently by 2 reviewers using established criteria, with consensus achieved through discussion. In this systematic review of 29 studies, the majority of studies demonstrated that migrant women were more likely to receive inadequate PNC than receiving-country women, with most reporting moderate to large effect sizes. Rates of inadequate PNC among migrant women varied widely by country of birth. Only three studies explored predictors of inadequate PNC among migrant women. These studies found that inadequate PNC among migrant women was associated with being less than 20 years of age, multiparous, single, having poor or fair language proficiency, education less than 5 years, an unplanned pregnancy, and not having health insurance. We concluded that migrant women as a whole were more likely to have inadequate PNC and the magnitude of this risk differed by country of origin. Few studies addressed predictors of PNC utilization in migrant women and this limits our ability to provide effective PNC in this population.     

Working Under a Clinic-Level Quality Incentive: Primary Care Clinicians’ Perceptions

BACKGROUND

A key consideration in designing pay-for-performance programs is determining what entity the incentive should be awarded to—individual clinicians or to groups of clinicians working in teams. Some argue that team-level incentives, in which clinicians who are part of a team receive the same incentive based on the team’s performance, are most effective; others argue for the efficacy of clinician-level incentives. This study examines primary care clinicians’ perceptions of a team-based quality incentive awarded at the clinic level.

METHODS

This research was conducted with Fairview Health Services, where 40% of the primary care compensation model was based on clinic-level quality performance. We conducted 48 in-depth interviews to explore clinicians’ perceptions of the clinic-level incentive, as well as an online survey of 150 clinicians (response rate 56%) to investigate which entity the clinicians would consider optimal to target for quality incentives.

RESULTS

Clinicians reported the strengths of the clinic-based quality incentive were quality improvement for the team and less patient “dumping,” or shifting patients with poor outcomes to other clinicians. The weaknesses were clinicians’ lack of control and colleagues riding the coattails of higher performers. There were mixed reports on the model’s impact on team dynamics. Although clinicians reported greater interaction with colleagues, some described an increase in tension. Most clinicians surveyed (73%) believed that there should be a mix of clinic and individual-level incentives to maintain collaboration and recognize individual performance.

CONCLUSION

The study highlights the important advantages and disadvantages of using incentives based upon clinic-level performance. Future research should test whether hybrid incentives that mix group and individual incentives can maintain some of the best elements of each design while mitigating the negative impacts.