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Hansen A, Schoenberg N, Oser C. Insights from obstetric providers and emergency medical technicians on determinants of maternal morbidity and mortality among underserved, rural patients in the United States. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 4:100320. [PMID: 38239392 PMCID: PMC10795728 DOI: 10.1016/j.ssmqr.2023.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Anna Hansen
- University of Kentucky, College of Medicine, USA
| | | | - Carrie Oser
- University of Kentucky, College of Medicine, USA
- University of Kentucky, College of Arts and Sciences, USA
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Vu M, Besera G, Ta D, Escoffery C, Kandula NR, Srivanjarean Y, Burks AJ, Dimacali D, Rizal P, Alay P, Htun C, Hall KS. System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers' perspectives. Front Glob Womens Health 2022; 3:1048700. [PMID: 36589147 PMCID: PMC9794861 DOI: 10.3389/fgwh.2022.1048700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers' desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Correspondence: Milkie Vu
| | - Ghenet Besera
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Danny Ta
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Namratha R. Kandula
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Amanda J. Burks
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Emory University Physician Assistant Program, School of Medicine, Emory University, Atlanta, GA, United States
| | - Danielle Dimacali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Pabitra Rizal
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Puspa Alay
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Cho Htun
- Center for Pan Asian Community Services, Atlanta, GA, United States
| | - Kelli S. Hall
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Moloney ME, Hansen A, Cockerham-Morris CT, Li J, Chavan NR. Appalachian Women's perspectives on preterm birth and transvaginal ultrasound cervical length screening: Implications for addressing disparities in preterm birth. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100558. [PMID: 34098320 DOI: 10.1016/j.hjdsi.2021.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Preterm birth (PTB), a pressing issue for US maternal-child health, disproportionately impacts women in Appalachia. Transvaginal ultrasound (TVU) cervical length (CL) screening is the most accurate PTB risk predictor but remains underutilized. This study characterizes the knowledge, attitudes and beliefs of patients with prior PTB concerning PTB prevention efforts and TVU CL screening. METHODS Participants were recruited from community-based health centers in Appalachian Kentucky. Semi-structured interviews and likert-scale surveys were conducted with 22 pregnant women with a history of spontaneous PTB. Methods for data collection were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Most participants reported that TVU was uncomfortable, but none refused it. Most women were able to articulate the benefits of TVU, but several had concerns about its safety in pregnancy. Participants suggested that pregnant women receive more PTB education and self-advocate. They urged providers to take patient concerns seriously, and better educate patients on PTB risks and TVU safety. DISCUSSION Our study contributes crucial insights about the experience of a vulnerable population as it pertains to PTB prevention and the uptake of TVU CL screening. Our findings emphasize the need for increased efforts to better educate patients on the impact of prematurity and the safety and benefits of TVU CL screening as an evidence-based strategy for PTB prevention.
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Affiliation(s)
- Mairead E Moloney
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Anna Hansen
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, KY, USA; College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Cynthia T Cockerham-Morris
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jing Li
- Center for Health Services Research (CHSR), College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Niraj R Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, College of Medicine, University of Kentucky, Lexington, KY, USA; Center for Health Services Research (CHSR), College of Medicine, University of Kentucky, Lexington, KY, USA.
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Hansen A, Moloney ME, Li J, Chavan NR. Preterm Birth Prevention in Appalachia: Restructuring Prenatal Care to Address Rural Health Disparities and Establish Perinatal Health Equity. Health Equity 2021; 5:203-209. [PMID: 33937606 PMCID: PMC8080929 DOI: 10.1089/heq.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: This perspective piece reflects off previously published qualitative work to explore (1) themes surrounding equitable prenatal care in Appalachia and (2) strategies to restructure care delivery in a population with disparate rates of preterm birth (PTB). Methods: This study reflects in-depth interviews with 22 Appalachian women who experienced PTB and 14 obstetric providers. Results: Our findings underscore the need for greater cultural humility in prenatal care, heightened awareness of social determinants of health, and strategic planning to establish equity in birth outcomes. Conclusion: Prenatal care must undergo a paradigm shift to include a comprehensive discussion of cultural humility, social disparities, and health equity.
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Affiliation(s)
- Anna Hansen
- Department of Sociology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Mairead E. Moloney
- Department of Sociology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Jing Li
- Center for Health Services Research (CHSR), University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Niraj R. Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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