Towards a patient-centered model of maternity care

Background/Significance: Disparities in access and utilization of prenatal care contribute to inequities in maternal-child health. Black women are twice as likely to receive inadequate or no prenatal care. Though barriers to prenatal care have been studied extensively, studies have not explored what women value and prioritize in prenatal care services. Objective/purpose: The purpose of this study was to qualitatively explore what low-income black women value in prenatal care and examine the factors that motivate and facilitate prenatal care attendance. Methods: Using a CBPR framework, focus groups were conducted with low-income, black parous women recruited through our community partner. Five focus groups comprised of 21 women were audiorecorded. Nominal group technique was utilized to determine how women ranked components of prenatal care. Transcripts were independently coded by two trained reviewers following a grounded theory approach. NVivo 9 facilitated analysis. Results: Women were primarily motivated to attend care by friends/family and concern for the baby's health. Facilitators for consistent attendance included transportation services and vouchers, social support, and education about social programs and resources. When asked what they would change in a ‘perfect system' women overwhelmingly commented on provider factors: namely, the discontinuity of care, lack of personal connection and relationship, and lack of caring or respect. Structural concerns, such as wait times and childcare needs were voiced by relatively few. Discussion/Conclusions: Future efforts to address disparities will need to develop more patient-centered models of maternity care. It is imperative that we begin by asking women what they prefer, need, and value.