ETHNIC DIFFERENCES IN PATIENT-PROVIDER INTERACTIONS IN PRENATAL CARE

Abstract

Prenatal care has been shown to be effective in improving the outcome of pregnancy among adolescents. However, little is known about the interactive process between the prenatal care provider and the adolescent, as well as how the process may be influenced by ethnicity. This study examined 191 patient-provider interactions among 110 pregnant adolescents (32 Anglo, 42 Mexican-American, 36 Mexican), ages 14-17 years, at their second and/or third trimester prenatal visit. Patient-provider encounters were audiotaped, and coded by a modified Roter Interaction Analysis including content and duration. Factor analysis was used to obtain summary measures, and non-parametric analyses were used for comparisons. It was found that the average total time of provider contact was 8.7 min. with the provider speaking 3.9 min. and the patient 1.4 min., with the only significant ethnic difference being in patient speaking time. Of these interactions, 43% addressed medical issues only, 32% included health education, and social issues were included in 25%. There were no ethnic differences in content. Analysis of the interaction process showed that Mexican adolescents received less provider conversation (P<.0001) and gave less patient conversation (P<.01) than Anglo or Mexican-Americans. Anglo adolescents had more interactive conversation than either Mexican-Americans or Mexicans (P<.0001). These findings support the hypothesis that the process of prenatal care is affected by the patient's ethnicity.