217076 What's Keeping Me From Early Prenatal Care?: Social justice and health literacy

Monday, November 8, 2010 : 8:50 AM - 9:05 AM

Bonnie Braun, PhD , Department of Family Science, University of Maryland School of Public Health, College Park, MD
Alice M. Horowitz, PhD , Center for Health Literacy, University of Maryland, College Park, MD
Nicole Finkbeiner, MS , Department of Family Science, University of Maryland, College Park, MD
Wendy Child, MS , Wendy Child Consulting, College Park, MN
Background: Maryland is one of the wealthiest states but ranks in the bottom third in infant mortality and low-birth weight infants. To address this disparity, legislators increased Medicaid eligibility for pregnant women in 2008. One year later, enrollment was not increasing within Prince George's County where rates exceeded Maryland's. This disparity prompted the state health department to ask why and what could be done to improve communications. Purpose: To determine the barriers and facilitators for receiving Medicaid and early prenatal care and to provide the state department with recommendations for closing the gap. Methods: A health literacy framework guided the qualitative study of eligible, pregnant African-American women ages 18-26 in Prince Georges' County. Data was collected from users, providers, experts and an assessment of materials. Focus groups with the women and interviews with health clinic staff and a community advocate were conducted. The Medicaid application and informational materials were analyzed using the Suitability of Materials assessment. Overall findings were reviewed by two external professionals with related national expertise. Results: Thirteen barriers and eight facilitators to enrollment and access to early prenatal care were identified ranging from intrapersonal to systems problems. None of the printed materials supplied by the state department of health met the standards of clear communications for health literacy; most had not been seen by the pregnant women. Findings were consistent with experiences of experts. Recommendations for revising the application and materials and for changes in dissemination may be applicable to other counties and states.

Learning Areas:
Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
To apply findings in practice settings serving low-income pregnant women. To analyze informational materials and channels of communication that help or hinder access to early prenatal care and Medicaid insurance using health literacy principles.

Keywords: Community-Based Health Care, Health Literacy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Endowed Chair and Director of the Herschel S Horowitz Center for Health Literacy and I conducted the research upon which this presentation is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.