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Abstract
BACKGROUND: Disparities in infant mortality may remain unchanged due to a variety of factors, specifically prenatal care. Prenatal care has been an entry point to the health care system. To improve prenatal care, effective and efficient patient provider communication that facilitates adherence to prenatal medical recommendations is essential. PURPOSE: This study aimed to validate a path-model of adherence to prenatal care recommendations among pregnant women. METHODS: A cross-sectional study utilizing a proposed theoretical framework was conducted among pregnant women (18-45 years) in their second or third trimester (n=401) who were receiving prenatal care from various community clinics and health care systems in Lucas County, Ohio. The proposed theoretical framework examined multiple levels of influences that affect adherence to prenatal care recommendations. A four-page, 111-item questionnaire was designed using modified preexisting instruments to validate the proposed theoretical framework. Path analysis was conducted to identify the best-fit path-model for adherence to prenatal care recommendations. RESULTS: In addition to multiple indirect predictors, motivation and shared decision-making significantly accounted for 10% (R2) of the variance in adherence to prenatal care recommendations. Patient’s trust, distrust, and self-efficacy accounted for 5% (R2) of patient’s motivation. Patient’s perceptions of cultural competency, interaction, perceived discrimination, and satisfaction accounted for 30% (R2) of the variance in shared decision-making. DISCUSSION: We identified the best-fit path-model for adherence to prenatal care recommendations. Our findings help improve adherence to prenatal care recommendations which could assist prenatal care providers in understanding complex variables affecting prenatal care, ultimately impacting infant mortality.
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