Prenatal Care Choices in Appalachia: A Qualitative, Critical Realist Description & Content Analysis

Introduction: Appalachian women have high rates of preterm birth and low birth weight infants. A new format of group prenatal care, known as CenteringPregnancy, decreases the rate of preterm birth and low birth weight when compared with individual care. However, clinics in Appalachia often struggle to recruit women into group care. Theory & Methods: Using critical realism and the middle-range theory of motivation-ease as frameworks, this qualitative study had two research questions: ‘What influences Appalachian women’s choice of traditional prenatal care instead of CenteringPregnancy care?’ and ‘What are Appalachian women’s perceptions of prenatal care and their access to prenatal care?’. Twenty-nine Appalachian women, who had declined CenteringPregnancy care, were interviewed about their perceptions of prenatal care, what facilitated care, and their decision to decline CenteringPregnancy. Verbatim transcripts of these semi-structured interviews, in-depth demographic questionnaires, and field notes were coded and analyzed using conventional (inductive) content analysis. Findings: Two meaning units were identified, information concerning women’s reason(s) for declining CenteringPregnancy and facilitators of prenatal care access. The reasons women provided for declining CenteringPregnancy care fell into three overarching categories, preferred one-to-one care, experienced barriers to Centering, and did not know Centering was an option. The most common reason for declining Centering was a preference for individual care. This category had three subcategories: do not like groups, don’t want to put everything out there with other women, and no need for change from existing care. Women predominately named two facilitators of prenatal care access, insurance and compassionate care. Conclusions: Clinicians should decrease barriers to CenteringPregnancy utilization and should partner with the local community to better market this new model of care. In addition, small modifications in Centering may make the model more appealing and accessible. However, clinicians should continue to provide individual care for women who cannot access group care. Participants stated state-provided insurance greatly facilitated prenatal care which supports the need for ongoing Medicaid funding. Women also stated compassionate care enhanced their ability and desire to get prenatal care. Healthcare providers should renew efforts to provide personalized and unrushed clinical environments to assist women in obtaining needed prenatal care.