Factors affecting perceived quality of prenatal care among disadvantaged women

Objective: This research was done as part of a needs assessment commissioned by a countywide perinatal services network. The goals of the research were to identify barriers to care for economically disadvantaged women, explore their experiences of care and determine which care needs were frequently met and unmet. Of particular concern were issues of communication with health care providers, and whether communication led to appropriate and needed services or care.

Method: The sponsoring perinatal organization sent flyers to all member agencies to recruit their clients; clients then volunteered through the member agencies. Data were collected via six semi-structured focus group interviews with 8-10 members each. Audiotapes of groups were transcribed verbatim, and coded by both authors. Analysis was based in grounded theory methodology, using open and then focused coding in iterative steps. Results: The two biggest factors in the women's perception of the quality of their care were 1) interpersonal issues with providers and staff and 2) the location of services (public clinics versus private physicians). Perceptions of disrespect, receiving fewer services than wealthier women, language barriers and lack of continuity of care produced strained communications and difficulty with shared decision-making between the women and their providers. Conclusions: The basis of the medical relationship extends beyond the exam room, and needs to be fostered at all levels to inspire trust and shared decision-making. Improvement could come from such basics as attention to staff attitudes and provider stereotypes and assumptions regarding lower SES women, as well as language and communication barriers.