Abstract
Background
Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts.
Objectives
This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community.
Methods
This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area.
Results
FTPNC was challenged by women’s immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education.
Conclusions for Practice
Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.
Significance
Minoritized communities have historically low FTPNC and PNCU. However, access and use of PNC may be affected and improved by specific communities’ cultural, social, and patient-provider interactions within specific geographical areas. For a primarily immigrant Latino community living in a midwestern metropolitan area, FTPNC and PNCU were challenged by immigration status, lack of healthcare coverage, difficulty completing public healthcare coverage application, cost of PNC when diagnosed with gestational diabetes, PNC literacy, limited access to women’s health providers, inadequate interpretation services, transportation, and mental health distress. However, social support, connectedness, appropriate interpretation services, bilingual providers, empathetic nonverbal communication, spoken communication strategies delivered at the provider’s office, access to PNC, and pregnancy prevention education were considered facilitators to FTPNC and PNCU.
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Data Availability
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Code Availability
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Acknowledgements
The authors would like to thank all participants in the study. The authors would also like to thank Juntos Center for Advancing Latino Health for helping to coordinate the study at community centers in Metro Kansas. Jay Doc Free Clinic, Johnson County Health Department, Wyandotte County Health Department, United Healthcare community outreach, University of Kansas Women’s Healthcare, and Uzazi Village for authorizing interviews. Least, but not last, our staff and collaborators: Ana Paula Cupertino, Ana Paulina Monroy, Andros Garcia Saldivar, Gonzalo Molina, Katia Arista, Nydia Marlene Smith, Norma Molina, Sarah Crawford, and Stephanie Horton.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publications of this article. Funding for the parent randomized clinical trial Assessment of Docosahexaenoic Acid On Reducing Early Preterm Birth (ADORE Trial) NICHD R01HD083292. Funding for this supplement study Finding Opportunities for Clinical Care and Trial Participation Among Underrepresented Samples (ADORE FOCUS) NICHD 3R01HD083292-02S1. Funding for JTC doctorate Brazilian National Council for Scientific and Technological Development (CNPq) – Science without borders (PICC 202992/2014-4), and Ringle Health Professions Scholarship – The University of Kansas Medical Center. The funders had no role in study design, data collection, data analysis, data interpretation, or manuscript writing.
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All authors participated sufficiently in the work to take public responsibility for the manuscript. S.E.C., E.H.K., B.J.G., and M.R. conceived the study’s idea and formulated the research question. J.T.C. and M.R. collected and managed data. The study analysis was designed by M.R., and J.T.C. led the data analysis, supported by M.R., E.H.K., and S.E.C. R.L.B., J.T.C., E.H.K., S.E.C., and M.R. contributed to the interpretation of the data. J.T.C., R.L.B., and L.S. drafted the initial manuscript and conducted the literature search. M.R. is the corresponding author. All authors have reviewed and approved the manuscript, and they have no conflicts of interest to disclose. This manuscript has not been published and is not under submission elsewhere.
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Camargo, J.T., Barral, R.L., Kerling, E.H. et al. Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest. Matern Child Health J 27, 1811–1822 (2023). https://doi.org/10.1007/s10995-023-03733-1
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DOI: https://doi.org/10.1007/s10995-023-03733-1