Shared stories as needs assessment data: The lives of women encountered in an outreach program

Efforts to reduce perinatal mortality have focused predominantly on medical care. However, women at most risk for adverse perinatal outcomes have numerous social problems affecting their ability to access prenatal care. Their social problems are generally not recorded in the medical record and these women are often hard to reach. Therefore, a needs assessment is difficult to conduct.

Data were collected from lay outreach workers who canvassed two low-income, predominantly African-American Chicago communities. Using a Voice-over IP system, over 13 months, seven lay outreach workers telephoned in 69 stories of women who faced particular hardships with the service delivery system. The stories were analyzed for themes that captured the texture of the lives of this hard-to-reach population. Both the outreach workers and the women who shared stories gave informed consent.

The themes included: general health issues (i.e., chronic illnesses), mental health issues (i.e., substance abuse, stress), pregnancy related health (i.e., abortions, wantedness), housing issues (i.e., homelessness), violence, and barriers to care (i.e., transportation, child care, insurance).

Those on the front-line of community-based public health efforts represent a largely untapped source of information and collaboration in public health intervention research. While initially it may not seem optimal to rely on second-hand reports for needs assessment purposes, we believe these data have high credibility and reliability, and that they provide important insights into unmet needs among hard-to-reach women at-risk for adverse pregnancy outcomes. This can inform development and modification of services to better address the life issues portrayed in these women's stories.