RT Journal Article
SR Electronic
T1 ‘Breaking It Down’: Patient-Clinician Communication and Prenatal Care Among African American Women of Low and Higher Literacy
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 334
OP 340
DO 10.1370/afm.548
VO 4
IS 4
A1 Ian Bennett
A1 Julia Switzer
A1 Abigail Aguirre
A1 Kelley Evans
A1 Frances Barg
YR 2006
UL http://www.annfammed.org/content/4/4/334.abstract
AB PURPOSE Low literacy has been associated with poor medical adherence, but its role in maternal care utilization has not been explored. METHODS We undertook a concurrent mixed methods study among 202 African American women of low (≤6th grade) and higher literacy receiving Medicaid. Poor use of prenatal care was defined by (1) starting care after the first trimester and (2) inadequate care utilization according to the Adequacy of Prenatal Care Utilization Index (APNCU). Participant-derived themes regarding prenatal care and care utilization were identified and explored through individual interviews (free listing and cultural consensus analysis; n = 40), and 4 confirmatory focus groups stratified by literacy. RESULTS Thirty-three women (16%) had low-literacy levels, 120 (61%) women started prenatal care after the first trimester, and 101 (50%) had inadequate utilization of prenatal care. Neither measure varied by literacy (P >.05). Cultural consensus analysis identified a single prenatal care factor that was comprised of 9 items, shared by women of low and higher literacy (eigenvalue 0.881, SD 0.058). Focus groups confirmed these items among participants from both literacy groups. Communication with clinicians was a central theme linking all of the factor items. Effective communication, exemplified by “breaking it down,” was described as encouraging, whereas ineffective communication discouraged use of care. CONCLUSION Women who had both low- and higher-literacy skills had high rates of poor prenatal care utilization and reported that communication with clinicians influenced their use of prenatal care. Improving the clarity of communication by breaking down information into simple parts should be a priority for prenatal clinicians.