Susan Vonderheid, PhD, RN , Funded Projects
Unpacking Group Prenatal Care: Impact & Change Mechanisms In Diverse Settings
Funding Source:: Health Resources and Services Administration
Dates: 2/1/10 - 1/31/13
Despite the highest health care expenditures per capita in the world, the US has the poorest perinatal outcomes among industrialized nations as well as persistent inequalities in prenatal care (PNC) and outcomes. The MCHB and Institute of Medicine have called for research on innovative models of prenatal care (PNC) to help improve quality of PNC and perinatal outcomes. The objective of this quasi-experimental study is to test the impact of an innovative group PNC model compared to individual PNC on pregnancy and perinatal health outcomes, and to examine the potential mechanisms that contribute to its effects. Centering Pregnancy (CP) is a nationally recognized group PNC model. In CP, after an individual first visit, 8-12 women at the same stage of pregnancy attend 10 two-hour visits together. CP provides: (1) substantially more time for health promotion designed to increase the number of health topics discussed; (2) group support designed to increase women’s social support; and (3) a collaborative patient-provider relationship and self-management activities designed to increase pregnancy-related empowerment. The only randomized clinical trial of CP found that the prematurity rate was significantly reduced for a large sample of mostly African American (AA) and Latina women; the reduction was even larger for AA. Now that these results suggest that CP is efficacious under experimental conditions, it is important to determine whether this innovative model can be effective in real world clinical settings. Moreover, no previous study has examined the mechanisms through which CP affects perinatal outcomes, which is essential for replication.
The proposed study takes advantage of a unique opportunity to study CP for women in a variety of clinics because the March of Dimes lllinois chapter recently funded initiation of CP in clinics across the state. Guided by a conceptual framework, we hypothesize that, compared with women in individual care, women in CP will have more favorable health outcomes in late pregnancy (health knowledge, healthy behaviors, prenatal weight gain, intention to breastfeed and to use the recommended infant sleep position, perceived stress, depressive symptoms, anxiety, prenatal care satisfaction, and PNC visit adherence); birth (prematurity, low birth weight); and early postpartum (breastfeeding initiation and use of the recommended infant sleep position). We also hypothesize that the effects of CP on health outcomes are mediated by health promotion content discussed, social support, and pregnancy-related empowerment. Low risk, predominantly low-income ethnically diverse women (n=1166 in CP and 1166 in individual care) will be recruited from 12 PNC clinics across Illinois. Our sample will include approximately 27% whites, 37.5% Latinas and 35% African Americans. With a retention rate of 90%, the final sample has 80% power to detect differences in preterm birth and more than sufficient power for other outcomes. Data will be obtained through two interviews (baseline, late pregnancy), a post-birth card or telephone call, and state birth certificates. An intent-to-treat analysis will be used. Logistic and multiple regression analyses with random effects to account for clustering will be used to test the hypotheses, controlling for potential confounders. Methodological strengths include a diverse sample large enough to detect differences in preterm birth, a process evaluation documenting intervention fidelity, and valid/reliable outcome measures for this population.