Women's narratives on “quality” in prenatal care: A multicultural perspective

Over the past 15 years, significant progress has been made to increase access to timely prenatal care. National agencies concerned with health equity and access articulate that further progress in eliminating disparities will require greater attention to quality of care. In particular, the National Healthcare Disparities Report (NHDR) of 2005 cites patient-centeredness as an important feature of quality of care. This study examined quality of prenatal care from the perspective of low income primiparous women from four ethnic groups: African American, Mexican, Puerto Rican and White. Using data from focus groups conducted in Chicago in 1995 we conducted a template analysis, mapping narrative data to domains of patient centeredness markers in the NHDR: “explained things”, “showed respect”, “spent enough time” and “listened carefully”. The narrative data were organized by ethnicity, value attributed to the prenatal care experience (positive or negative), and the extent to which the grounded categories reflected the patient-centeredness domains of the NHDR. The markers in order of the frequency with which they were represented in the data are “explained things”, “showed respect”, “spent enough time” and “listened carefully”. Across the focus groups, approximately two-thirds of the categorized statements provided by the women were negatively framed and one-third were positively framed, reflecting either desirable or undesirable aspects of women's overall prenatal care experiences. White women's remarks were the most negatively framed. The women's narratives suggest a critical and intuitive understanding of the NHDR patient centeredness markers. Implications for improving quality and its measurement in prenatal care are discussed.