Roman Lee Anne, Raffo Jennifer E, Dertz Katherine, Agee Bonita, Evans Denise, Penninga Katherine, Pierce Tiffany, Cunningham Belinda, VanderMeulen Peggy
Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, E Fee Hall, 965 Fee Rd Room A629-b, East Lansing, MI, 48824, USA.
Department of Obstetrics, Gynecology & Reproductive Biology, Michigan State University, 15 Michigan Street NE, Grand Rapids, MI, 49503, USA.
Matern Child Health J. 2017 Dec;21(Suppl 1):81-92. doi: 10.1007/s10995-017-2372-2.
Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a local Federal Healthy Start (HS) program in Michigan that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.
目标 为解决不良分娩结局方面的差异，各社区面临着提高卫生服务质量和促进系统整合的挑战。本研究的目的是探讨参加医疗补助计划的女性对其在一系列临床和社区服务中的围产期护理（PNC）经历的看法。方法 开展了3个焦点小组（N = 21），并采用主题分析方法来确定有关护理经历的基本主题和总体主题。通过密歇根州当地一个针对非裔美国女性的联邦健康开端（HS）项目招募女性。结果 确定了4个基本主题：（1）寻求围产期护理；（2）传统围产期护理经历；（3）强化产前和产后护理；以及（4）女性健康：一个错失的机会。还确定了2个总体主题：（1）与医护人员的沟通，以及（2）感知到的社会经济和种族偏见。许多女性在接受早期护理、获得更多帮助以及与医护人员理解和沟通方面遇到困难，一些人报告在护理中存在社会经济和种族偏见。围产期护理的延迟限制了早期获得健康开端项目和强化产前护理（EPC）项目的机会，几乎没有证据表明向初级护理有支持性的过渡。值得注意的是，女性的叙述显示临床服务和社区服务之间几乎没有联系。结论 参与围产期护理和社区项目的过程对女性来说具有挑战性，尤其是对于那些有多种健康问题且生活处境困难的女性。围产期护理、健康开端项目和其他强化产前护理项目可以合作简化流程、改善护理内容和过程，并提高对服务的参与度。
