Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Netw Open. 2022 Oct 3;5(10):e2238161. doi: 10.1001/jamanetworkopen.2022.38161.
Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care.
To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes.
DESIGN, SETTING, AND PARTICIPANTS: For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user's perspective) and ideation (generating novel potential solutions). Questions targeted participants' experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign.
Preferences for prenatal care redesign.
Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers.
In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients' needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients' social needs and preferences.
在美国，收入较低的黑人孕妇在获得医疗保健方面存在不平等，其结果也是如此，但他们的声音在重新设计产前护理方面基本上没有被听到。
为了了解低收入黑人人群中产前护理服务的患者和医疗保健工作者的经验，以便为改善护理协调、获取、质量和结果的创新提供信息。
设计、地点和参与者：在这项定性研究中，在密歇根州底特律的产前护理诊所进行了以人为中心的设计为导向的访谈，参与者包括 19 名低收入黑人孕妇（目前怀孕或分娩后 1 年内）和 19 名医疗保健工作者（如医生、护士和社区卫生工作者），访谈时间为 2019 年 10 月 14 日至 2020 年 2 月 7 日。问题集中在以人为中心的设计的两个阶段：观察（从最终用户的角度了解问题）和构思（生成新颖的潜在解决方案）。问题针对产前护理的三个目标：医疗护理、预期指导和社会支持。采用折衷的分析策略，包括归纳主题分析和矩阵编码，以确定产前护理重新设计的有前途的策略。
对产前护理重新设计的偏好。
19 名黑人患者（平均[标准差]年龄 28.4[5.9]岁；19[100%]女性；17[89.5%]有公共保险）和 19 名医疗保健工作者中的 17 名（平均[标准差]年龄 47.9[15.7]岁；15 名女性[88.2%]；13[76.5%]黑人）完成了调查。包括了各种医疗保健工作者（例如医生、导乐和社会工作者）。尽管所有人都肯定了产前护理的三个目标，但参与者报告了每个产前护理领域的失败和潜在解决方案。在两个交叉领域也出现了主题：从业者和护理基础设施。参与者报告说，理想情况下，护理结构将使患者和从业者之间建立强大的持续关系。从业者将协调所有产前服务，而不仅仅是医疗保健。最后，通过使用护理导航员、灵活的模式和服务的集中化来减少障碍，可以根据患者的个体需求定制护理。
在密歇根州底特律的这项针对低收入黑人孕妇及其护理人员的定性研究中，产前护理服务未能满足许多患者的需求。参与者报告说，理想的护理模式将包括整个医疗保健系统的全面、综合服务，不仅包括医疗保健，还包括患者的社会需求和偏好。
