Taking advantage of a hospital-provided appointment-tracking tool with incorporated prenatal care tips and resources can significantly benefit all pregnant women but especially women with lower incomes, according to a recent article by Advocate Health Care researchers.
“Patient-reported benefits of this pregnancy support tool – including navigating their insurance, making financial tradeoffs, showing up on time to appointments, or feeling their time was being respected – indicate that the U.S. health care system can do a better job guiding women with lower incomes through their pregnancy care journey,” said lead author Anne Rivelli, MPH, Senior Epidemiologist for Advocate Aurora Research Institute.
The article, published in the Journal of Primary Care & Community Health, reports the researchers’ findings from a pilot study centered around the use of a pregnancy support tool, called the CONTINUE Tool, in prenatal care. The tool itself is a trifold paper brochure that includes tips for handling clinic appointments, suggested questions for physicians and insurance companies, a space to track clinic visits, labs and ultrasounds, and information on how to access additional resources. It is designed to improve communication between health care providers and expectant mothers and to help them follow their personalized prenatal care plan.
"The tool provides an overview of the entire 10 months of prenatal care, which allows our patients to plan in advance for visits and the associated costs for transportation and child care. Birth equity and equity in quality prenatal care is so important to us as we serve our diverse community here in the city of Chicago," said generalist obstetrician gynecologist Leah Delfinado, MD, coauthor of the paper.
By comparing survey results from study participants who were on public insurance with those on private insurance, the researchers reported that women with lower incomes found the CONTINUE Tool to be more useful than women with higher incomes, sometimes by a significant margin, according to 18 different items.
The 18 items fell into four different categories: time-related benefits (e.g., participants were more likely to attend and show up on time for appointments), cost-related benefits (e.g., participants showed a better understanding of insurance and felt that care providers considered their finances), patient understanding (e.g., participants were better able to explain their care plan to their families and understand the purpose of different appointments), and efficacy benefits (e.g., participants felt more in control of their care and more trusting in their care team).
Women with lower incomes were four times more likely than women with higher incomes to experience time-related logistics benefits, more than three times as likely to experience cost-related logistics benefits, nearly twice as likely to report improved understanding and 30% more likely to experience efficacy benefits.
Previous studies have shown the immense value of pregnancy support tools for all women, but few studies have gauged the specific effect these tools have on the prenatal care of women with lower incomes.
“Research shows women with lower incomes tend to face all sorts of systemic barriers to adequate prenatal care participation, including higher likelihood of missing appointments, feelings of being misunderstood and fears of stigmatization,” said Veronica Fitzpatrick, DrPH, Research Scientist for the Research Institute and coauthor of the paper. “And given how important prenatal care is to safe and healthy pregnancies, it’s no surprise then that health outcomes for mom and baby are especially poor for this group. All of which is why there is a definite need for new tools and approaches to overcome these barriers.”
Advocate Health Care epidemiologist Maureen Shields, obstetrician gynecologist Marie Cabiya, MD, and Nurse Midwife Supervisor Karen Wennerberg, CNM, also coauthored the paper.
The CONTINUE Tool was designed with input from clinicians and expectant mothers with lower incomes. Previous studies also found that a paper-based tool produced better results than a smartphone-based tool, since a paper-based tool can be customized in real-time to the patient.
Researchers provided the CONTINUE Tool to 184 women, with 71 agreeing to participate in the study and 34 completing the survey on the tool’s usefulness. Study participants came from three Advocate Health Care obstetrics clinics in the northern-Chicago area.
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