Most data analysis techniques such as regression or correlation, are variable-centered. These techniques attempt to explain how one variable, such as age, is related to another variable, such as parenting practices. In contrast, person-centered approaches attempt to identify subgroups within populations based on their similarities, often across many variables. Person-centered approaches are particularly useful for elucidating phenomena that are multidimensional, such as parenting practices and health behaviors. A person-centered approach is valuable when examining issues related to health equity, as it can more accurately describe multifaceted identities.

In this presentation, we will demonstrate a person-centered approach to examining social determinants of health in Minnesota’s federally-funded Family Home Visiting programs. CHAID (Chi-square automatic interaction detection) is a decision tree technique that identifies subgroups of individuals with multiple shared characteristics. This method assesses distinct subgroups in relation to the outcome variable and elucidates the defining characteristics that set these groups apart. We will demonstrate the use of the CHAID technique to examine disparities in maternal depression screening. The presentation will demonstrate how person-centered techniques such as CHAID can isolate health disparities differently than variable-centered approaches.

These results highlight the importance of considering intersecting risk factors when examining intervention outcomes. Person-centered methods can help promote equity in targeted service interventions by identifying intersectional identities associated with health disparities. This enables service providers to promote equitable outcomes by better understanding where to target interventions.

Background This study investigates the impact of perinatal staffing, including nurse midwives, on low birthweight (LBW) births in health centers.

Methods Using 2011-2021 Uniform Data System files, we examined 4 staffing models in 1,385 health centers: those with no certified nurse midwives (CNMs) or obstetricians (OBs) (“non-CNM/OB”), CNM-only, OB-only, and both CNMs and OBs (“CNM/OB”). We compared unadjusted and adjusted mean LBW rates (per 100 births) across staffing models, overall and by race/ethnicity patient groups. Multi-level analyses used generalized linear models with time and center fixed effects. We derived predicted mean LBW rates adjusted for patient, organizational, and community characteristics.

Results Unadjusted and adjusted mean LBW rates exhibited similar patterns. Adjusted LBW rates ranged from 7.6% in CNM-only centers to 10.1% in non-CNM/OB centers. Among Black births, LBW rates ranged from 10.1% (CNM-only) to 13.5% (non-CNM/OB). OB-only and CNM/OB centers had similar adjusted rates (9.1% overall, 12.3% among Black births). This pattern was consistent among other race/ethnicity groups across staffing models. CNM-only, OB-only and CNM/OB centers were similarly concentrated in counties with low access to perinatal providers (CNM-only = 10%; OB-only=13%; CNM/OB=8%) and served similar proportions of high-risk prenatal patients (CNM-only=11%; OB-only=13%; CNM/OB=12%).

Conclusions: Findings suggest access to the CNM workforce may reduce perinatal inequities, as CNM-only health centers had lower LBW rates than OB-only and CNM/OB, despite similarities in high-risk patient proportions and being located in low perinatal access counties. Future workforce policies should support health centers’ employment of CNMs as a critical member of the reproductive team.

Background: The US faces maternal and child health (MCH) crises with rising mortality rates and racial disparities. Doula services show improved outcomes but face integration obstacles into healthcare systems, an issue that remains challenging in Nashville and Omaha, where this study was conducted. This qualitative study aims to assess perceived challenges and facilitators in integrating doula services into perinatal care systems, as identified by public health professionals and doulas, and formulate recommendations for policy changes to improve MCH outcomes.

Methods: 15 interviews were conducted with participants involved in MCH organizations, including doulas and public health professionals. Interviews explored roles, experiences, and perspectives on integrating doula services. Thematic and framework analyses identified key themes.

Results: 5 themes emerged: 1) Doulas Matter, doulas provide vital advocacy, support, education, and improving outcomes; 2) Integration Needed, integration requires collaborative approaches recognizing doulas on healthcare teams and formal professional recognition; 3) Obstacles include institutional resistance, cost barriers, Medicaid reimbursement complexity, lack of supportive policies; 4) Enabling Factors involve education campaigns, insurance coverage policies, community engagement); 5) Policy Recommendations include formal state recognition via licensure/certification, mandating Medicaid/private insurance coverage, public awareness initiatives highlighting doulas benefits, establishing training standards, and funding for workforce development.

Conclusions: These findings underscore doulas’ vital role in enhancing MCH outcomes yet reveal systemic barriers impeding their integration into perinatal care systems. Enacting supportive policies is crucial to overcoming integration barriers, ensuring equitable access to doula support, and ultimately improving MCH and reducing persistent health disparities - a pressing public health priority.

BACKGROUND: Nurse-Family Partnership (NFP) is an evidence-based nurse home-visiting program typically serving first-time pregnant individuals referred and enrolled prior to 28-weeks gestation. In 2021, NFP sites in Florida participated in a pilot study to expand access by encouraging referrals and enrollment after 28 weeks including people with previous births. We aimed to determine if the expansion increased equitable access to people most likely to benefit from NFP.

METHODS: We conducted a mixed-methods cohort study from 1/1/21 to 12/31/22 using matched state-level and NFP databases and 30 interviews of NFP supervisors, nurses, clients, and referral partners. Chi-square and t-tests were conducted to compare ‘late’ and ‘on-time’-referred groups. We conducted thematic analysis with multiple coders and wrote memos to synthesize qualitative findings.

RESULTS: 5,106 pregnant individuals were referred to NFP from 1/1/21 through 12/31/22; 9.2% were referred after 28 weeks. ‘Late’-referrals were less likely to have been born in the US (p=.02); more likely to have been pregnant previously (p<.01) and have other children in the home under age 5 (p<.01) ; less likely to have a 1st trimester prenatal visit (p<.01); and more likely to report smoking prior to pregnancy (p<.01). Qualitative interviews revealed reasons for late referrals, including challenges accessing timely prenatal care, program waitlists, and systems-level barriers.

CONCLUSIONS: 'Late’ referral to NFP increases access for people with risks for poor health outcomes. Systems to identify and refer pregnant people who would benefit from services can be improved.

Background: A continuum of maternal healthcare before, during, and after pregnancy, influences optimal health of mothers and infants. However, limited population-based research examined risk factors of neglected maternal care across its spectrum. This study explored patterns and disparities of preconception, prenatal, and postpartum care utilization among women in Virginia.

Methods: We used data from the 2016 - 2020 Virginia Pregnancy Risk Assessment Monitoring System (VA-PRAMS), representative sample surveys of women recruited 4-6 months postpartum (N = 4,843). The maternal care spectrum was assessed in relation to receiving a primary care visit (PCV) within a year of conception, timing of the first prenatal care visit (PNCV), and having a postpartum visit (PPV) 4-6 weeks after delivery. Multivariable logistic regression was employed to examine factors related to missing or delayed maternal care visits, adjusting for sociodemographic characteristics.

Results: Over one-third of women had no preconception PCV (37.14%), one in ten had delayed PNCV (11.92%), and missed their PPV check-up (11.50%). Missed or delayed care was significantly associated with younger age, lower income, and no insurance coverage (p <0.001). Relative to White women, minority women had significantly increased odds of no PCV (African-American AOR: 1.57, 95% CI: 1.17–2.18); Hispanic AOR: 1:71, 95% CI: 1.23 – 2.37); Asian and other AOR: 2.41, 95% CI: 1.68-3.45).

Conclusion: The study highlighted disparities of care across the spectrum of maternity among minority and socioeconomically disadvantaged Virginia women, which highlighted the need for better-equipped healthcare services for expecting mothers, and eventually policy implementation to improve maternal healthcare utilization.