Exploring the group prenatal care model: a critical review of the literature

Maternal satisfaction with group care: a systematic review

OBJECTIVE

This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care.

DATA SOURCES

We searched CINAHL, Clinical Trials, The Cochrane Library, PubMed, Scopus, and Web of Science databases from the beginning of 2003 through June 2023.

STUDY ELIGIBILITY CRITERIA

We included studies that reported the association between overall maternal satisfaction and centering-based perinatal care where the control group was standard individual care. We included randomized and observational designs.

METHODS

Screening and independent data extraction were carried out by 4 researchers. We extracted data on study characteristics, population, design, intervention characteristics, satisfaction measurement, and outcome. Quality assessment was performed using the Cochrane tools for Clinical Trials (RoB2) and observational studies (ROBINS-I). We summarized the study, intervention, and satisfaction measurement characteristics. We presented the effect estimates of each study descriptively using a forest plot without performing an overall meta-analysis. Meta-analysis could not be performed because of variations in study designs and methods used to measure satisfaction. We presented studies reporting mean values and odds ratios in 2 separate plots. The presentation of studies in forest plots was organized by type of study design.

RESULTS

A total of 7685 women participated in the studies included in the review. We found that most studies (ie, 17/20) report higher satisfaction with group care than standard individual care. Some of the noted results are lower satisfaction with group care in both studies in Sweden and 1 of the 2 studies from Canada. Higher satisfaction was present in 14 of 15 studies reporting CenteringPregnancy, Group Antenatal Care (1 study), and Adapted CenteringPregnancy (1 study). Although indicative of higher maternal satisfaction, the results are often based on statistically insignificant effect estimates with wide confidence intervals derived from small sample sizes.

CONCLUSION

The evidence confirms higher maternal satisfaction with group care than with standard care. This likely reflects group care methodology, which combines clinical assessment, facilitated health promotion discussion, and community-building opportunities. This evidence will be helpful for the implementation of group care globally.

A systematic review of providers' experiences of facilitating group antenatal care

Background

Group antenatal care is a rapidly expanding alternative antenatal care delivery model. Research has shown it to be a safe and effective care model for women, but less is known about the perspectives of the providers leading this care. This systematic review examined published literature that considered health care professionals’ experiences of facilitating group antenatal care.

Methods

Systematic searches were conducted in seven databases (Cinahl, Medline, Psychinfo, Embase, Ovid Emcare, Global Health and MIDRS) in April 2020. Qualitative or mixed methods studies with a significant qualitative component were eligible for inclusion if they included a focus on the experiences of health care providers who had facilitated group antenatal care. Prisma screening guidelines were followed and study quality was critically appraised by three independent reviewers. The findings were synthesised thematically.

Results

Nineteen papers from nine countries were included. Three main themes emerged within provider experiences of group antenatal care. The first theme, ‘Giving women the care providers feel they want and need’, addresses richer use of time, more personal care, more support, and continuity of care. The second theme, ‘Building skills and relationships’, highlights autonomy, role development and hierarchy dissolution. The final theme, ‘Value proposition of group antenatal care’, discusses provider investment and workload.

Conclusions

Health care providers’ experience of delivering group antenatal care was positive overall. Opportunities to deliver high-quality care that benefits women and allows providers to develop their professional role were appreciated. Questions about the providers’ perspectives on workload, task shifting, and the structural changes needed to support the sustainability of group antenatal care warrant further exploration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01200-0.

Receiving antenatal care in a group setting has been found to be safe and satisfying for women and is supported by international public health guidelines. However, questions remain about the experience of health care professionals tasked with providing this model, such as whether they like working in this model and whether they support its expansion. To answer these questions, the team searched for studies about the experiences of health care providers with group antenatal care, and only included those studies where providers themselves spoke about their own experiences of providing this kind of care. Our review demonstrated that midwives, doctors, nurses and community health workers mostly enjoyed facilitating group antenatal care. They particularly appreciated the ability to give women the kind of care they felt women want and need. Health care providers also experienced some changes in their professional roles, in relation to both the women they serve and their colleagues and organizations. In order to determine if group antenatal care models are a satisfying and sustainable option for health care professionals in the long term, more research is needed.

Examining the Feasibility of Smart Blood Pressure Home Monitoring: Advancing Remote Prenatal Care in Rural Appalachia

BACKGROUND

Hypertensive disorders of pregnancy are a leading cause of U.S. maternal morbidity and mortality. Home blood pressure (BP) monitoring can provide early detection of hypertension (HTN) outside of routine prenatal visits. Yet little is understood about how well self-monitored BP performs during pregnancy, particularly in rural America.

OBJECTIVE

To examine the feasibility and patient adherence to a self-monitoring BP program and to remotely collect data on pregnant women during the third trimester at a rural health clinic.

MATERIALS AND METHODS

A repeated-measures prospective design was used to remotely monitor home BP readings. We examined retention and persistence of weekly BP monitoring in late-stage pregnancy, differences between weekly self-monitored and clinic BP measures, the performance of self-monitored BP in early detection of pregnancy-induced HTN, and receptivity to technology-enabled prenatal monitoring.

RESULTS

A total of 30 women enrolled. Women reported high satisfaction with prenatal care, but missed 5 out of 13 clinic visits (54%). Women contributed an average of 31.2 days of home BP monitoring. Findings showed that home systolic and diastolic BP readings slightly varied from clinic readings. Women reported high health-related internet use and e-health literacy. Participants (93%, n = 25) reported a willingness to change their behavior during pregnancy in response to personalized recommendations from a smartphone. Although preliminary, we confirmed that remote monitoring can detect elevated BP earlier than in routine clinic visits.

CONCLUSION

Findings from this study can be used to inform a novel remote monitoring protocol to improve pregnancy care in a rural care setting.

Assessing the impact of group antenatal care on gestational length in Rwanda: A cluster-randomized trial

BACKGROUND

Research on group antenatal care in low- and middle-income contexts suggests high acceptability and preliminary implementation success.

METHODS

We studied the effect of group antenatal care on gestational age at birth among women in Rwanda, hypothesizing that participation would increase mean gestational length. For this unblinded cluster randomized trial, 36 health centers were pair-matched and randomized; half continued individual antenatal care (control), half implemented group antenatal care (intervention). Women who initiated antenatal care between May 2017 and December 2018 were invited to participate, and included in analyses if they presented before 24 weeks gestation, attended at least two visits, and their birth outcome was obtained. We used a generalized estimating equations model for analysis.

FINDINGS

In total, 4091 women in 18 control clusters and 4752 women in 18 intervention clusters were included in the analysis. On average, women attended three total antenatal care visits. Gestational length was equivalent in the intervention and control groups (39.3 weeks (SD 1.6) and 39.3 weeks (SD 1.5)). There were no significant differences between groups in secondary outcomes except that more women in control sites attended postnatal care visits (40.1% versus 29.7%, p = 0.003) and more women in intervention sites attended at least three total antenatal care visits (80.7% versus 71.7%, p = 0.003). No harms were observed.

INTERPRETATION

Group antenatal care did not result in a difference in gestational length between groups. This may be due to the low intervention dose. We suggest studies of both the effectiveness and costs of higher doses of group antenatal care among women at higher risk of preterm birth. We observed threats to group care due to facility staff shortages; we recommend studies in which antenatal care providers are exclusively allocated to group antenatal care during visits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03154177.

The Role of Antenatal Education in Promoting Maternal and Family Health Literacy

BACKGROUND

Antenatal education (ANE) supports expectant parents in developing their knowledge, skills, and confidence in preparing for childbirth and early parenting. This is called health literacy, and it is part of the global healthcare system agenda that empowers women to participate fully in making decisions about their health and care before, during, and after birth. The aim of this study was to examine the perspectives of educators and ANE class participants on the extent to which existing courses are meeting this goal.

METHODS

A qualitative study, conceptualized within the health literacy framework, was conducted in Australia with 10 antenatal educators and 8 participants from antenatal classes. Data were collected through individual interviews and were analyzed using interpretive description.

RESULTS

The findings revealed five themes relating to the participants' experiences in either providing or attending antenatal classes. These included: “balancing provider influences with participant expectations,” “accommodating participant learning styles and preferences,” “influence of the environment on pedagogy and practice,” “empowering participants for decision-making,” and “reflections on what is and is not meaningful and effective.”

CONCLUSIONS

Findings from this study strongly suggest that to meet the needs of class participants, educators need to be mindful of their expectations. They should adopt a flexible approach to accommodate participants' knowledge, goals, and preferences as well as characteristics of the context. Conceptualizing ANE within the framework of health literacy provides a clear, targeted approach to meeting the information needs of this important population that is focused on evidence-based safe practice across the birthing continuum and beyond.

The Effects of Childbirth Education on Maternity Outcomes and Maternal Satisfaction

Past evaluation of the effectiveness of childbirth education classes related to obstetric outcomes and satisfaction with the birth experience have not shown consistent results. This study explored the relationship between attendance of set curriculum childbirth education class and the labor and birth process, as well as maternal satisfaction with the birth experience. Participants were 197 low-risk, primiparous women, self-selected into two groups consisting of 82 women who attended a childbirth class and 115 women who did not. Data were collected from medical records and a postpartum satisfaction survey was completed by each participant. The authors designed the Likert-type satisfaction survey based on "control" as a key factor in satisfaction. Data analysis revealed that women who took a class were less likely to be induced and had lower use of analgesics during labor. A logistical regression model showed that an increase in the number of interventions increased the risk for cesarean surgery for all women. Labor interventions were used significantly less in women who took a childbirth class. No statistical difference was seen in the perception of control or overall satisfaction of the birth experience. Childbirth education may help women prepare for what to expect in birth and minimize the use of medical interventions.

An overview of advances in global maternal health: From broad to specific improvements

After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially increased. The present article highlights an overview, namely 10 of the health system, clinical, and technology-based advancements that have occurred in the past three decades in the field of global maternal health. The list of topics has been selected through the cumulative clinical and public health expertise of the authors and is certainly not exhaustive. Rather, the list is intended to provide a mapping of key topics arranged from broad to specific that span from the global policy level to the level of individual care. The list of health system, clinical, and technology-based advancements include: (10) Millennium Development Goals and Sustainable Development Goals; (9) Development of clinical training programs, including the potential for subspecialty development; (8) Prenatal care expansion and potential; (7) Decentralized health systems, including the use of skilled birth attendants; (6) Antiretroviral therapy for HIV; (5) Essential medicines; (4) Vaccines; (3) mHealth/eHealth; (2) Ultrasonography; and (1) Obstetric hemorrhage management. With the Sustainable Development Goals now underway, the field must build upon past successes to sustain maternal and neonatal well-being in the future global health agenda.

"…Society is, at the end of the day, still going to stigmatize you no matter which way": A qualitative study of the impact of stigma on social support during unintended pregnancy in early adulthood

Unintended pregnancy in adolescence and early adulthood is stigmatized in the United States because it deviates from social norms that consider young people’s sexuality as a social problem. While limited, prior research has found that this stigma prevents young people from telling people in their lives about their pregnancies, for fear of judgment or negative reactions. We hypothesized that this selective disclosure of unintended pregnancy due to stigma would reduce the social support available to young pregnant people at a particularly vulnerable time—social support that we know is important for optimal physical and mental health of the young person, and the pregnancy (should they choose to carry to term). To explore this hypothesis, we conducted a qualitative study among young people to understand if and how they experienced stigma in relation to an unintended pregnancy, how this stigma shaped patterns of pregnancy disclosure, the implications for received social support, and participant thoughts on how to alleviate the influence of this stigma on their lives. In in-depth interviews with 25 young people in the San Francisco Bay area who had experienced at least one unintended pregnancy, using a thematic analysis approach, we found that the stigma of unintended pregnancy led participants to selectively disclose the pregnancy to limited people, which in turn cut them off from needed sources of social support. Black and Hispanic women disproportionately described this experience. Participants expressed a desire for programs that would connect young people who had experienced unplanned pregnancy to each other–either via the internet, organized groups through clinical care sites, college or high school campuses, or other forums—as a way to alleviate stigma, share perspectives and lessons learned, and otherwise build emotional and informational support networks for themselves where their usual support had fallen away.

Women's Perceived Quality of Care and Self-Reported Empowerment With CenteringPregnancy Versus Individual Prenatal Care

OBJECTIVE

To compare perceived quality of prenatal care and pregnancy-related self-reported empowerment between women participating in CenteringPregnancy versus those receiving individual prenatal care provided by certified nurse-midwives in the same clinic.

DESIGN

Nonexperimental, longitudinal, descriptive feasibility study of two independent groups.

SETTING/LOCAL PROBLEM

A prenatal clinic in northern Texas where all care is provided by certified nurse-midwives.

PARTICIPANTS

The study assessed 51 women receiving self-selected prenatal care in the form of individual prenatal care (n = 37) or CenteringPregnancy (n = 14).

INTERVENTION/MEASUREMENTS

Outcomes analyzed included perceived quality of prenatal care and pregnancy-related self-reported empowerment.

RESULTS

The results showed no statistical significance between the individual prenatal care and CenteringPregnancy groups with regard to perceived quality of prenatal care or pregnancy-related self-reported empowerment.

CONCLUSION

CenteringPregnancy has the capability to provide women with quality of care equal to that achieved through traditional prenatal care. Despite the lack of statistically significant findings, this study exposes several areas of interest and provides guidance for future studies evaluating prenatal care.

Father's Lifetime Socioeconomic Status, Small for Gestational Age Infants, and Infant Mortality: A Population-Based Study

Objective

To ascertain the association between father's lifetime socioeconomic status (SES) and rates of small for gestational age (SGA, defined as weight for gestational age <10th percentile) and infant mortality (defined as <365 days).

Methods

The study sample was limited to the singleton births of African American (n=8,331), non-Latina White (n=18,200), and Latina (n=2,637) women. Stratified and multilevel, multivariable logistic regression analyses were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data (n=29,168). The median family income of father's census tract residence during childhood and parenthood were used to assess lifetime SES.

Results

Births (n=8,113) to fathers with a lifetime low SES had a SGA rate of 13.3% compared with 6.6% for those (n=10,329) born to fathers with a lifetime high SES, RR = 1.97 (1.79, 2.17). The infant mortality rate of births to fathers with a lifetime low SES exceeded that of infant mortality rate of births to fathers with a lifetime high SES: 13/1,000 vs 5/1,000, respectively; RR = 2.71 (1.94, 3.77). The adjusted (controlling for mother's age, education, marital status, and race/ethnicity) OR of SGA for fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.15 (1.01, 1.31), 1.13 (1.02, 1.26), and 1.19 (1.05, 1.34), respectively. The adjusted OR of infant mortality for births to fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.14 (.78, 1.67), 1.40 (.90, 2.18), and 1.31 (.90, 1.92), respectively.

Conclusions

Low paternal socioeconomic status is a previously unrecognized determinant of SGA birth regardless of mother's demographic status.

Intention to Participate in Group Prenatal Care: Moving Beyond Yes or No

Group prenatal care (GPNC) is an alternative model to traditional individual care and may improve public health outcomes. Prior studies suggest that interest in GPNC varies widely and few studies have examined characteristics predictive of interest in this model. The purpose of this study was to inform GPNC recruitment efforts by examining likelihood of participation delineated by characteristics and GPNC perceptions. Pregnant participants received information about GPNC then completed a survey measuring demographic, psychosocial, and reproductive characteristics, likelihood to participate in GPNC, and factors influencing selections. Respondents expressed varied levels of likelihood to participate in GPNC; 16.2% low likelihood, 44.9% moderate likelihood, and 38.9% high likelihood. Characteristics were similar between groups, and thus their use is not recommended when targeting recruitment efforts. Benefits outweighed barriers and threats for the high likelihood category, barriers and threats outweighed benefits for the low likelihood category, and benefits, barriers, and threats were balanced for the moderate likelihood category. Accurately assessing likelihood of participating in GPNC efficiently identifies individuals who are clearly either going to decline or participate, as well as promotes targeted recruitment efforts directed at those who are ambivalent. Understanding and addressing perceived benefits, barriers, and threats supports effective GPNC recruitment.

Improving Prenatal Care for Minority Women

Since the inception of prenatal care in the early 1900s, the focus of care has been on risk reduction rather than on health promotion. Prenatal care began as individualized care, but more recently group prenatal care has been shown to be very successful in improving birth outcomes. For all women, an emphasis on improving health behaviors is important at this critical time while women are engaging regularly with the healthcare system. An emphasis on mental health promotion may decrease some of the disparities in birth outcomes that are well documented between minority and majority women, as minority women are known to experience increased levels of stress, anxiety, and depression. Providing support for pregnant women and incorporating knowledge and skills through prenatal care may promote both physical and mental health in minority women.

The Relationships of Health Behaviour and Psychological Characteristics with Spontaneous Preterm Birth in Nulliparous Women

Objectives Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. Our aim was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. Methods The data of our prospective study was obtained from the nationwide DELIVER multicentre cohort study (September 2009–March 2011), which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth as a dichotomous outcome. Due to the clustering of clients within midwife practices, Generalized Estimating Equations was used for these analyses. Results Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth (odds ratio 2.26; 95 % confidence interval 1.51, 3.39) after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics. The other characteristics were not significantly associated with spontaneous preterm birth. Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth.

Women's Health Outpatient Care Teams: Focus on Advanced Practice Providers

Team-based care in the outpatient women's health setting has the potential to help alleviate the demand for women's health care providers and to deliver improved quality of care to the growing population of US women. Although teamwork is necessary in the current health care system, most of the current obstetrics and gynecology and advanced practice provider (APP) workforce were not trained for collaborative practice. Core competencies for building an effective outpatient women's health care team are explained and current evidence regarding the specific role of APPs in women's health care is reviewed.

The Gestational Diabetes Group Program

The purpose of the Gestational Diabetes Group Program (GDGP) was to provide patients with diabetes self-management education that occurs in a supportive, prenatal group care setting. The Centering Pregnancy Interdisciplinary Model of Empowerment and the Chronic Care Model guided the program. The pilot project took place at an urban clinic that cares for a diverse, underserved population. The GDGP, a series of four prenatal group sessions after the diagnosis of gestational diabetes and one postpartum group, used an interprofessional/interdisciplinary approach to care with the groups cofacilitated by certified nurse-midwives, certified diabetes nurse-educators, and other community partners. The program was able to show statistically significant changes in knowledge and empowerment, optimal pregnancy outcomes, and high patient satisfaction.

Effectiveness of CenteringPregnancy on Breastfeeding Initiation Among African Americans: A Systematic Review and Meta-analysis

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiation among only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed.

Future Directions in the Study of Early-Life Stress and Physical and Emotional Health: Implications of the Neuroimmune Network Hypothesis

Early-life stress is associated with increased vulnerability to physical and emotional health problems across the lifespan. The recently developed neuroimmune network hypothesis proposes that one of the underlying mechanisms for these associations is that early-life stress amplifies bidirectional crosstalk between the brain and the immune system, contributing to several mental and physical health conditions that have inflammatory underpinnings, such as depression and coronary heart disease. Neuroimmune crosstalk is thought to perpetuate inflammation and neural alterations linked to early-life stress exposure, and also foster behaviors that can further compromise health, such as smoking, drug abuse and consumption of high-fat diets. The goal of the present review is to briefly summarize the neuroimmune network hypothesis and use it as a starting point for generating new questions about the role of early-life stress in establishing a dysregulated relationship between neural and immune signaling, with consequences for lifespan physical and emotional health. Specifically, we aim to discuss implications and future directions for theory and empirical research on early-life stress, as well as for interventions that may improve the health and well-being of children and adolescents living in adverse conditions.

Managing parental groups: personal impact of a group leadership course for child healthcare nurses

AIMS AND OBJECTIVES

To investigate the experience and personal impact of a group leadership course for child healthcare nurses.

BACKGROUND

During their child's first year, all parents in Sweden are invited to participate in parental groups within the child health service; however, only 49% choose to participate. Despite extensive experience, child healthcare nurses find managing parental groups challenging and express a need for training in group dynamics and group leadership.

DESIGN

The study was designed as a controlled study with a pretest/post-test design where the participants form their own control group.

METHODS

A group leadership course was given to 56 child healthcare nurses and evaluated in a pre- and postintervention questionnaire, a course evaluation and an interview with the course leaders.

RESULTS

The child healthcare nurses felt their group leadership skills were strengthened and the majority (96%) felt that the course had changed their way of leading parental groups. They felt that the group leader role had been clarified and that they had obtained several new tools to use in their groups.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Clarifying the role of group leader and adding knowledge about group leadership and dynamics seems to have increased the self-confidence for child healthcare nurses in group leadership. Improved confidence in group management might motivate the child healthcare nurses to further develop parental groups to attract the parents who currently choose not to participate.

Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance

PURPOSE

Group models of prenatal care continue to grow in popularity. However, little is known about how group composition (similarity or diversity between members of groups) relates to care-related outcomes. The current investigation aimed to explore associations between prenatal care group composition with patient satisfaction, engagement, and group attendance among young, urban women of color.

METHODS

Data were drawn from two studies conducted in New Haven and Atlanta (2001-2004; n = 557) and New York City (2008-2011; n = 375) designed to evaluate group prenatal care among young, urban women of color. Women aged 14 to 25 were assigned to group prenatal care and completed surveys during their second and third trimesters of pregnancy. Group attendance was recorded. Data were merged and analyzed guided by the Group Actor-Partner Interdependence Model using multilevel regression. Analyses explored composition in terms of age, race, ethnicity, and language.

MAIN FINDINGS

Women in groups with others more diverse in age reported greater patient engagement and, in turn, attended more group sessions, b(se) = -0.01(0.01); p = .04.

CONCLUSION

The composition of prenatal care groups seems to be associated with young women's engagement in care, ultimately relating to the number of group prenatal care sessions they attend. Creating groups diverse in age may be particularly beneficial for young, urban women of color, who have unique pregnancy needs and experiences. Future research is needed to test the generalizability of these exploratory findings.

Which Pregnant Adolescents Would be Interested in Group-Based Care, and Why?

STUDY OBJECTIVE

To determine if pregnant adolescents interested in group-based prenatal care have different demographic and psychosocial characteristics than those interested in individual prenatal care. Factors that influence the preferred model of prenatal care patients were assessed.

DESIGN, SETTING, AND PARTICIPANTS

Prospective comparison of demographic and psychosocial characteristics of 153 pregnant adolescents enrolled in an adolescent-oriented prenatal and pediatric program at Children's Hospital Colorado.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Pregnant study participants were queried and their preferred mode of prenatal care and reasons for that preference were examined.

RESULTS

Younger (16 years and younger) and primiparous adolescents were more likely to be interested in group care. Those not interested in group-based care were more likely to smoke and wanted to be pregnant. Most participants were interested in group-based prenatal care to belong to a peer group, receive additional education and support, and to have fun. Reasons participants were not interested in group-based care included concerns about belonging to a group, preferring individual care, and experiencing logistical concerns such as scheduling conflicts, limited transportation, and childcare resources.

CONCLUSIONS

Identifying which patients are interested in group prenatal care influences development of the program model and recruiting procedures, maximizing the effectiveness of the program by offering services based on patient needs. Identifying factors that influence patients' prenatal care choices enables providers to offer support to reduce barriers to participation and structure care that is best suited to patients willing to commit to and engage in the program.