Does increasing access improve adherence to psychosocial interventions in prenatal care?

Background

Psychosocial and behavioral factors may contribute to the disproportionate risk of African American women for adverse pregnancy outcomes. Yet, only 20% of women comply with healthcare provider referrals to psychosocial interventions. Co-location of psychosocial risk reduction counseling within the prenatal care clinic may improve intervention adherence.

Purpose

To identify factors associated with intervention participation for low income African American women with psychosocial risks when services are co-located in prenatal clinic sites.

Methods

As part of the NIH-DC Initiative to Reduce Infant Mortality in Minority Populations, African American women in prenatal care (N=521) at 6 clinic sites, were screened for smoking, environmental tobacco smoke exposure, depression and intimate partner violence. Baseline measures included risk factors, demographics, partner relationship, and social support. As part of an RCT, women who screened with risk were offered individual counseling, conducted at the time of her prenatal clinic visits. The goal was 8 prenatal plus 2 postpartum sessions, with 4 sessions considered minimally adequate exposure.

Results

Women attended a mean of 4.6(SDą3.32) prenatal and postpartum counseling sessions, with 60% of women attending at least 4 of the intervention sessions. Logistic regression models identified predictors of attending less than half of the expected number of prenatal intervention sessions, based on the expected number of prenatal care visits for each woman. Lower attendance was predicted by not having a current partner (OR=1.84, 95% CI 1.12-3.01) and smoking (OR=1.61,CI 1.00-2.60). In a second logistic regression model, attending fewer prenatal intervention sessions was predicted by entering prenatal care in the 2nd vs 1st trimester (OR=2.03,CI 1.45-2.84), and smoking (OR=1.66, CI 1.12-2.48); and in a third model, only by the number of prenatal care visits attended (OR=0.68,CI 0.64-0.72).

Conclusions

Co-location of services yielded more favorable adherence to psychosocial interventions than has been suggested in previous studies when services were separately located. Not having a partner during pregnancy may decrease motivation for healthcare or increase the daily demands on low income, single women, making prenatal clinic visit attendance difficult. Pregnant smokers may wish to avoid negative reactions anticipated from healthcare staff, or put lower value on preventive health measures during pregnancy. Improving access enhances participation, but challenges remain in helping women recognize the relevance of psychosocial risk intervention in improving outcomes for herself and her infant.

Funded by NICHD and NCMHHD.