产前护理的障碍：与中西部一个中产阶级社区护理开始延迟相关的因素。

Barriers to prenatal care: factors associated with late initiation of care in a middle-class midwestern community.

作者信息

Roberts R O, Yawn B P, Wickes S L, Field C S, Garretson M, Jacobsen S J

机构信息

Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota, USA.

出版信息

J Fam Pract. 1998 Jul;47(1):53-61.

PMID:9673609

Abstract

BACKGROUND

Barriers to prenatal care have been extensively investigated in low-income and inner-city communities. Less attention has been directed to the study of prenatal care among middle- and upper-class pregnant women. This study describes perceived barriers and factors associated with late initiation of prenatal care in a predominantly middle- to upper-class midwestern community.

METHODS

Consenting women in Olmsted County, Minnesota, who were attending a clinic for their first obstetric visit completed a self-administered questionnaire that queried the presence of factors making it difficult to receive prenatal care, perception about the importance of prenatal care, expectations at the first prenatal care visit, and sociodemographic factors.

RESULTS

Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women reported external barriers to receiving prenatal care. These factors included difficulty in getting an appointment (46.9%), problems finding child care (26.5%), and lack of transportation (14.3%). In multivariable logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very important (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7-9.7); external barriers to prenatal care (OR = 2.9, 95% CI, 1.6-5.4); annual income < $17,000 (OR = 2.9, 95% CI, 1.5-5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3-3.5). Multiparous women and women older than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5-14.6 and OR = 2.9, 95% CI, 1.2-6.8, respectively).

CONCLUSIONS

These findings suggest that perceptions about the importance of prenatal care may play a greater role in the initiation of care among this group of women than is recognized. Women with more experience with pregnancy appear to place slightly less importance on prenatal care.

摘要

背景

低收入和市中心社区的产前护理障碍已得到广泛研究。中上层阶级孕妇的产前护理研究受到的关注较少。本研究描述了一个主要为中上层阶级的中西部社区中，产前护理开始较晚的感知障碍及相关因素。

方法

明尼苏达州奥尔姆斯特德县同意参与研究的妇女，她们首次到产科诊所就诊时完成了一份自填式问卷，问卷询问了导致难以接受产前护理的因素、对产前护理重要性的看法、首次产前检查的期望以及社会人口学因素。

结果

在813名年龄在14至47岁的妇女中，692名（86%）在怀孕的头三个月内进行了首次产前检查。只有98名（12%）妇女报告了接受产前护理的外部障碍。这些因素包括难以预约（46.9%）、难以找到儿童护理（26.5%）和缺乏交通工具（14.3%）。在多变量逻辑回归分析中，护理开始较晚与患者认为产前护理不太重要有关（比值比[OR]=4.1，95%置信区间[CI]，1.7 - 9.7）；产前护理的外部障碍（OR = 2.9，95% CI，1.6 - 5.4）；年收入<17,000美元（OR = 2.9，95% CI，1.5 - 5.7）；以及意外怀孕（OR = 2.1，95% CI，1.3 - 3.5）。经产妇和35岁以上的妇女更有可能认为产前护理不太重要（分别为OR = 3.9，95% CI，2.5 - 14.6和OR = 2.9，95% CI，1.2 - 6.8）。