Maternal and Child Health Journal

, Volume 2, Issue 1, pp 15–24 | Cite as

Perceptions of Motivators and Barriers to Public Prenatal Care Among First-Time and Follow-Up Adolescent Patients and Their Providers

  • Sarah E. TeagleEmail author
  • Claire D. Brindis


Objectives: To compare perceptions of the motivators and barriers to obtaining public prenatal care from the perspectives of pregnant adolescents coming for first-time and follow-up appointments, as well as among those of their prenatal care providers. Method: The patient sample consisted of 250 consecutive, adolescent, public prenatal patients coming to one of the 5 prenatal clinics in one county in Arkansas. Patient responses were analyzed by appointment status (first-time vs. follow-up visitors). Sixteen providers at the same public prenatal clinics were also interviewed using the same survey instrument. Results: We observed striking differences between patients and providers with respect to their perceptions of both the motivators and barriers to prenatal care. Adolescents reported “concern over the health of their baby” as a primary motivation, while providers identified adolescents' “concern over their own health” as the most important reason. With regard to barriers, adolescents were more likely to identify system-related barriers (e.g., lack of finances and transportation, and waiting time for appointments), while providers were more likely to identify personal barriers (e.g., feeling depressed, fear of procedures, and needing time to deal with problems at home). Patients and providers agreed, however, that fear of procedures and not wanting to be pregnant were important barriers to care. Conclusions: The differences in perceptions between adolescents and their prenatal care providers suggest that poor patient–provider communication may represent one of the single most important nonfinancial barriers to care. Possible explanations for inadequate patient–provider communication as well as solutions to improve their clinic interactions are discussed.

Adolescent pregnancy prenatal care service access patient–provider communication participatory decision making 


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  1. 1.
    Ershoff DH, Quinn VP, Mullen PD, Lairson DR. Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in an HMO. Public Health Rep 1990;105:340–47.Google Scholar
  2. 2.
    Horgan C, Rosenbach M, Otsby E, Butrica B. Targeting special populations with drug abuse problems: Pregnant women. National Institute on Drug Abuse, Drug Abuse Research Series 1991;1:123–43.Google Scholar
  3. 3.
    Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures. JAMA 1994;271:1340–44.Google Scholar
  4. 4.
    Sable MR, Herman AA. The relationship between prenatal health behavior advice and low birth weight. Public Health Rep 1997;112:332–39.Google Scholar
  5. 5.
    Cornelius MD, Day NL, Cornelius JR, Taylor PM, Richardson GA. Drinking patterns and correlates of drinking among pregnant teenagers. Alcohol Clin Exp Res 1993;17:290–94.Google Scholar
  6. 6.
    McBride CM, Pirie PL. Postpartum smoking relapse. Addic Behav 1990;15:165–68.Google Scholar
  7. 7.
    Brown SS. Drawing women into prenatal care. Fam Plann Perspect 1989;21:73–80.Google Scholar
  8. 8.
    National Center for Health Statistics. Advance report on final natality statistics, 1988. Mon Vital Stat Rep 1990;29:2–4.Google Scholar
  9. 9.
    Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med 1995;332:1113–7.Google Scholar
  10. 10.
    Cooper LG, Leland NL, Alexander G. Effect of maternal age on birth outcomes among young adolescents. Social Biol 1995;42:22–35.Google Scholar
  11. 11.
    National Center for Health Statistics. Advance report of final natality statistics 1992. Mon Vital Stat Rep 1994;43:1–26.Google Scholar
  12. 12.
    Wells RD, McDiarmid J, Bayatpour M. Perinatal health belief scales: A cost-effective technique for predicting prenatal appointment keeping rates among pregnant teenagers. J Adolesc Health 1990;11:119–24.Google Scholar
  13. 13.
    Lia-Hoagberg B, Rode P, Skovholt CJ, Oberg CN, Berg C, Mullett S, Choi T. Barriers and motivators to prenatal care among low-income women. Soc Sci Med 1990;30:487–95.Google Scholar
  14. 14.
    Young CL, McMahon JE, Bowman VM, Thompson DS. Psychosocial concerns of women who delay prenatal care. Families in Society 1990;September:408–14.Google Scholar
  15. 15.
    Goldenberg RL, Patterson ET, Freese MP. Maternal demographic, situational and psychosocial factors and their relationship to enrollment in prenatal care: A review of the literature. Women Health 1992;19:133–51.Google Scholar
  16. 16.
    Blankenson ML, Goldenberg RL, Keith B. Noncompliance of high-risk pregnant women in keeping appointments at an obstetric complications clinic. South Med J 1994;87:634–8.Google Scholar
  17. 17.
    McDonald TP, Coburn AF. Predictors of prenatal care utilization. Soc Sci Med 1988;27:167–72.Google Scholar
  18. 18.
    York R, Grant C, Gibeau A, Beecham J, Kessler J. A review of problems of universal access to prenatal care. Nurs Clin North Am 1996;31:279–92.Google Scholar
  19. 19.
    Scupholme A, Robertson EG, Kamons AS. Barriers to prenatal care in a multiethnic urban sample. J Nurse Midwifery 1991;36:111–6.Google Scholar
  20. 20.
    Joyce TJ, Grossman M. Pregnancy wantedness and the early initiation of prenatal care. Demography 1990;27:1–17.Google Scholar
  21. 21.
    Cartwright PS, McLaughlin FJ, Martinez AM, Caul DE, Hogan IG, Reed GW, Swafford MS. Teenagers' perceptions of barriers to prenatal care. South Med J 1993;86:737–41.Google Scholar
  22. 22.
    Poland ML, Ager JW, Olson JM. Barriers to receiving adequate prenatal care. Am J Obstet Gynecol 1987;157:297–303.Google Scholar
  23. 23.
    Kalmuss D, Fennelly K. Barriers to prenatal care among low-income women in New York City. Fam Plann Perspect 1990;22:215–8.Google Scholar
  24. 24.
    Kinsman SB, Slap GB. Barriers to adolescent prenatal care. J Adolesc Med 1992;13:146–54.Google Scholar
  25. 25.
    Baker TJ. Factors related to the initiation of prenatal care in the adolescent nullipara. Nurse Pract 1996;21:29–32.Google Scholar
  26. 26.
    Irwin CE, Millstein SG, Ellen JM. Appointment-keeping behavior in adolescents: Factors associated with follow-up appointment-keeping. Pediatrics 1993;92:20–3.Google Scholar
  27. 27.
    Aved BM, Irwin MM, Cummings LS, Findeisen N. Barriers to prenatal care for low-income women. West J Med 1993;158:493–8.Google Scholar
  28. 28.
    McKillip J. Need analysis. Newbury Park, CA: Sage Publications, 1987.Google Scholar
  29. 29.
    Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians' participatory decision-making style. Med Care 1995;33:1176–87.Google Scholar
  30. 30.
    Institute of Medicine—Brown S, editor. Prenatal care: Reaching mothers, reaching infants. Washington DC: National Academy Press, 1988.Google Scholar
  31. 31.
    Browner CH, Press N. The production of authoritative knowledge in American prenatal care. Med Anthropol Q 1996;10:141–56.Google Scholar
  32. 32.
    Ford CA, Millstein SG, Halpern-Felsher BL, Irwin CE. Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. JAMA 1997;278:1029–34.Google Scholar
  33. 33.
    Ginsburg KR, Menapace AS, Slap GB. Factors affecting the decision to seek health care: The voice of adolescents. Pediatrics 1997;100:922–30.Google Scholar
  34. 34.
    Hornberger JC, Itakura H, Wilson SR. Briding language and cultural barriers between physicians and patients. Public Health Rep 1997;112:410–7.Google Scholar
  35. 35.
    Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians' participatory decision-making style: Results from the Medical Outcomes Study. Med Care 1995;33:1176–87.Google Scholar
  36. 36.
    Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med 1996;42:1511–19.Google Scholar
  37. 37.
    Stensland P, Malterud K. New gateways to dialogue in general practice: Development of an illness diary to expand communication. Scand J Prim Health Care 1997;15:175–9.Google Scholar
  38. 38.
    DeValck C, Van de Woestijne KP. Communication problems on an oncology ward. Patient Educ Couns 1996;29:131–6.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  1. 1.Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel HillU.S.A
  2. 2.Center for Reproductive Health Policy Research, Institute for Health Policy Studies, and Department of Pediatrics, both at theUniversity of California atSan Francisco

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