Abstract
BackgroundWe describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.MethodsA secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.ResultsAlthough common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation.ConclusionsActively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.
Highlights
We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service
The impact of premature births on infant mortality may be larger than indicated by standard preterm birth rates
Development of a knowledge base of the barriers to interconceptional preventive care is critical and timely to inform the process of building this preventive service
Summary
We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service. Problem statement Preterm birth remains a leading cause of infant mortality, for African American women. The impact of premature births on infant mortality may be larger than indicated by standard preterm birth rates. A “preterm-related infant mortality rate” is a measure of aggregate deaths across all underlying causes documented by ICD-9. At least 75% of the preterm related deaths occur among infants born less than 37 weeks gestation [1,2]. The preterm related infant mortality rate for blacks (6.01) is 3.4 times higher than for whites (1.79), and in. The various underlying causes of infant mortality pose a challenge in finding appropriate intervention approaches. The current approach relies heavily on the provision of prenatal care, which has not been effective in reducing the preterm-related causes of IM, nor in reducing the disparity between Blacks and Whites
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