Consumer assessment of the quality of interpersonal processes of prenatal care among ethnically diverse low-income women: Development of a new measure

doi:10.1016/j.whi.2004.04.003

Women's Health Issues

Volume 14, Issue 4, July–August 2004, Pages 118-129

https://doi.org/10.1016/j.whi.2004.04.003 Get rights and content

Abstract

Purpose

Consumer assessments of interpersonal processes of care during prenatal care provide important information about how well clinicians satisfy the perceived needs of the women they serve, but few measures are available that tap the various components of these processes. The purpose of this study is to develop a multidimensional measure of prenatal interpersonal processes of care (PIPC) that demonstrates reliability and validity in ethnically diverse women in Medicaid managed care plans.

Methods

A telephone survey of African American, Latino (U.S. and foreign born) and Caucasian pregnant women in four Medicaid managed care plans in California was conducted in English and Spanish in 2001. Factor analytic methods were used to test the PIPC measures. A psychometric evaluation, including reliability, variability, and construct validity, was conducted with the final scales for the total sample and for each racial/ethnic group.

Results

Three dimensions, Communication, Patient-Centered Decision Making, and Interpersonal Style, with seven scales were supported with 30 items. The scales for each dimension exhibit acceptable reliability for the total sample (Internal Consistency Reliability ranged from 0.66 to 0.85) and for all racial/ethnic groups. All scales had significant associations with satisfaction with prenatal care and explained considerable variation in satisfaction (19–43%). The scale qualities and validity associations held for all scales and ethnic groups except some scales for U.S.-born Latinas.

Conclusions

The multidimensional PIPC measure for assessing what actually happens between providers and low-income pregnant women of diverse ethnic groups demonstrates acceptable reliability and construct validity.

Section snippets

Sample and procedures

Medicaid health plans in four San Francisco Bay Area counties (Alameda, Contra Costa, San Francisco, Santa Clara) in California took part in our study. All plans were owned and operated by local county governments, and most women received care from public clinics and hospitals, though private physicians and clinics did participate in some plans.

African-American, Latino, and Caucasian pregnant women, ages 18 to 44 years, were eligible to participate if they were between 24 and 32 weeks’

Results

Of the original sampling frame, 363 women completed the survey (response rate of 41%). About half (51%) could not be reached because of incorrect telephone contact information or they were not reachable despite repeated attempts (at least three at different times of the day and evening). The response rate among those who were contacted was 81%. Response rates for the different ethnic groups could not be determined because the race/ethnicity of all women listed was not known. About three

Discussion

We developed a 30-item instrument of reports of (PIPC). Seven scales reflect three underlying dimensions: Communication, Patient-Centered Decision Making, and Interpersonal Style. This instrument was tested in women from three racial/ethnic groups (African-American, Latino, Caucasian) using two languages (English and Spanish). The choice of items was guided by a conceptual framework of dimensions of interpersonal processes of care (Stewart et al., 1999). The PIPC instrument appears to be easy

Conclusion

The rise of consumerism, the role of the government as a payer of health services, and an increasingly competitive health care marketplace has increased interest in consumer assessments of providers. The rise of consumerism, the role of the government as a payer of health services, and an increasingly competitive health care marketplace has increased interest in consumer assessments of providers (Marshall, Morales, Elliott, Spritzer, & Hays, 2001). In a review of how quality report cards are

Acknowledgements

This study was funded by a Grant R40MC00137 from the Maternal and Child Health Bureau, U.S. DHHS. The authors are grateful to the research team members who were instrumental in survey design and focus group facilitation: Maria Fongwa and Martha Castrillo; and in survey data collection: Adrienne Brown, Martha Castrillo, Phaedra Harris, Constance McCoy, and Thu Quach. We wish to express a special thanks to the health plans and the women who participated in the focus groups and the survey needed

Dr. Wong’s research focuses on psychometric evaluation of measures across diverse populations and examining the determinants of health disparities.

References (44)

E. Berkanovic et al.
Mexican-American, black-American and white-American differences in reporting illnesses, disability and physician visits for illnesses
Social Science and Medicine
(1985)
K.M. Brett et al.
Differences between black and white women in the use of prenatal care technologies
American Journal of Obstetrics and Gynecology
(1994)
J.A. Hall et al.
Patient sociodemographic characteristics as predictors of satisfaction with medical carea meta-analysis
Social Science and Medicine
(1990)
A. Handler et al.
Prenatal care characteristics and African-American women’s satisfaction with care in a managed care organization
Women’s Health Issues
(2003)
M. Kuppermann et al.
Racial-ethnic differences in prenatal diagnostic test use and outcomespreferences, socioeconomics, or patient knowledge?
Obstetrics and Gynecology
(1996)
D. Oakley et al.
Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives
Obstetrics and Gynecology
(1996)
D. Roter
The enduring and evolving nature of the patient-physician relationship
Patient Education Counseling
(2000)
J.G. Bertolino et al.
Patient and physician characteristics associated with perceived quality of care
Family Practice Research Journal
(1993)
R.W. Brislin
Translationapplication and research
(1976)
999 birth cohort file
(1999)

P. Cleary

The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement

British Medical Journal

(1999)

P.D. Cleary et al.

Patient satisfaction as an indicator of quality care

Inquiry

(1988)

L. Cooper et al.

Patient-provider communicationeffect of race/ethnicity on process and outcomes of healthcare

Unequal treatmentrole of social and psychological research in medicine

(2002)

K. Covinsky et al.

Differences in patient-reported processes and outcomes between men and women with myocardial infarction

Journal of General Internal Medicine

(2000)

M. Doescher et al.

Racial and ethnic disparities in perceptions of physician style and trust

Archives of Family Medicine

(2000)

F.J. Fowler

M. Gold et al.

Surveying consumer satisfaction to assess managed-care qualitycurrent practices

Health Care Financing and Review

(1995)

S. Greenfield et al.

Patients’ participation in medical careeffects of blood sugar control and quality of life in diabetes

Journal of General Internal Medicine

(1988)

A. Handler et al.

Health care characteristics associated with women’s satisfaction with prenatal care

Medical Care

(1998)

J. Jewett et al.

Comprehension of quality care indicatorsdifferences among privately insured, publicly insured, and uninsured

Health Care Financing and Review

(1996)

S.H. Kaplan et al.

Assessing the effects of physician-patient interactions on the outcomes of chronic disease

Medical Care

(1989)

B.E. Landon et al.

Quality management practices in Medicaid managed carea national survey of Medicaid and commercial health plans participating in the Medicaid program

Journal of the American Medical Association

(1999)

Cited by (38)

Measuring women's empowerment during the perinatal period in high income countries: A scoping review of instruments used
2023, Heliyon
Empowerment is acknowledged as a process facilitating those who are less powerful to be engaged in their problem identification, decision making and actions to gain control over their life. This is an important goal for women during the perinatal period in their transition to motherhood. A concept analysis of women's empowerment during the perinatal period found that psychological and social dimensions play a role in women's perinatal empowerment and identified several defining attributes.
The aim of this study was to identify robust validated instruments that measure all the attributes of women's empowerment during the perinatal period.
We did a scoping review of scientific literature following the methodology of the JBI Reviewer's Manual. We searched the database MEDLINE, CINAHL, PsycINFO, PsycARTICLES and SocINDEX and selected papers meeting the inclusion criteria. Instruments measuring empowerment or related concepts were identified in the selected papers. Two authors independently cross referenced the items of each instrument against the defining attributes for empowerment.
Our search resulted in 9771 unique hits of which 36 papers were finally included. Studies were from various countries with a wide variety of aims, demographics of cohorts and timepoints across the perinatal period. Twenty-one different instruments were used to measure empowerment, of which 11 were validated among women during the perinatal period. However, no identified instrument was developed specifically for women during the perinatal period or included all the dimensions of empowerment and the defining attributes.
There is a need for a theoretically sound valid and reliable instrument measuring all the dimensions of empowerment of women during the perinatal period. Once developed this instrument needs testing with a broad range of women. Results from such a study will inform the development of appropriate interventions that have a coherent theoretical basis and are empirically informed to enhance women's empowerment during the perinatal period.
Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring
2019, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Perception of the quality of prenatal care received was measured at 36 weeks of gestation by a modified validated 30-item Prenatal Interpersonal Processes of Care scale, which assessed communication, decision making, and interpersonal style. Responses were converted to a 0- to 100-point scale for each sub-scale item, with higher scores indicating higher perceived quality of care.18 Effectiveness of the OB Nest intervention was evaluated by proxy measures including adherence to the ACOG-recommended routine prenatal laboratory services, ultrasound imaging, immunization, and patient education.
Standard prenatal care, consisting of 12–14 visits per pregnancy, is expensive and resource intensive, with limited evidence supporting the structure, rhythm, or components of care. Some studies suggest a reduced-frequency prenatal care model is as safe as the standard model of care for low-risk pregnant women, but evidence is limited. We developed and evaluated an innovative, technology-enhanced, reduced prenatal visit model (OB Nest).
To evaluate the acceptability and effectiveness of OB Nest, a reduced-frequency prenatal care model enhanced with remote home monitoring devices and nursing support.
A single-center randomized controlled trial, composed of pregnant women, aged 18–36 years, recruited from an outpatient obstetric tertiary academic center in the Midwest United States. OB Nest care consisted of 8 onsite appointments with an obstetric provider; 6 virtual visits consisting of phone or online communication with an assigned nurse, supplemented with fetal Doppler and sphygmomanometer home monitoring devices; and access to an online community of pregnant women. Usual care consisted of 12 prescheduled prenatal clinic appointments with obstetric providers. Acceptability of OB Nest was measured by validated surveys of patient satisfaction with care at 36 weeks; perception of stress at 14, 24, and 36 weeks; and perceived quality of care at 36 weeks of gestation. Effectiveness was analyzed by comparing adherence to the American College of Obstetricians and Gynecologists recommended routine prenatal and ancillary services, maternal and fetal safety outcomes, and healthcare utilization.
Three hundred pregnant women at <13 weeks of gestation were recruited and randomized to OB Nest or usual care (150 in each arm) using a minimization algorithm. Demographic characteristics were similar between groups. Compared to usual care, patients in OB Nest had higher satisfaction on a 100-point validated modified Littlefield and Adams Satisfaction scale (OB Nest = 93.9% vs usual care = 78.9%, P < .01). Pregnancy-related stress, measured, on a 0–2 point PreNatal Maternal Stress validated scale, with higher scores indicating higher levels of stress, was lower among OB Nest participants at 14 weeks (OB Nest = 0.32 vs usual care = 0.41, P < .01) and at 36 weeks of gestation (OB Nest = 0.34 vs usual care = 0.40, P < .03). There was no statistical difference in perceived quality of care. Adherence to the provision of American College of Obstetricians and Gynecologists prenatal services was similar in both arms. Maternal and fetal clinical outcomes were similar between groups. Total reported nursing time was higher in OB Nest (OB Nest = 171.2 minutes vs usual care = 108.2 minutes, 95% confidence interval, 48.7–77.4).
OB Nest is an innovative, acceptable, and effective reduced-frequency prenatal care model. Compared to routine prenatal care, OB Nest resulted in higher patient satisfaction and lower prenatal stress, while reducing the number of appointments with clinicians and maintaining care standards for pregnant women. This program is a step toward evidence-driven prenatal care that improves patient satisfaction.
Applying the chronic care model to prenatal care: Patient activation, productive interactions, and prenatal outcomes
2018, Patient Education and Counseling
Citation Excerpt :
PAM was repeated at time 4 (32-week appointment). Following each appointment, the pregnant women completed five subscales of the validated Prenatal Interpersonal Processes of Care (PIPC) scale [26], including elicitation/responsiveness to the patient, explanations of care, empowerment, patient-centered decision making, and emotional support. Responses to each item were transformed onto a 0 (negative perception) to 100 (positive perception) scale, and items are averaged to create subscales.
To demonstrate how the chronic care model can be applied in prenatal care.
This study was conducted through analysis of data generated in the women’s health and family medicine departments of one community hospital and two medical centers across three states (Georgia, Nevada, and Virginia). 159 low-risk obstetric patients were monitored throughout their pregnancy for patient activation and biometric measures including: blood pressure at each appointment, baby’s gestational age at birth, and mode of delivery. Patient activation was assessed with the validated, licensed patient activation measure.
Patient activation was strongly associated with the Prenatal Interpersonal Processes of Care metric (F (2, 155) = 3.41, p < .05). Also, increased age, decreased Prenatal Interpersonal Processes of Care, fewer pregnancies, and increased diastolic blood pressure were associated with an increased likelihood of cesarean delivery and the model correctly predicted 81% of cases.
Women who identified as feeling more activated reported more positive pregnancy experiences, and women who reported more positive pregnancy experiences were more likely to experience a vaginal delivery.
Activated patients, more positive prenatal experience, and improved delivery outcomes can be achieved through applying the chronic care model.
Mobile application as a prenatal education and engagement tool: A randomized controlled pilot
2016, Patient Education and Counseling
Citation Excerpt :
Then, they reported how frequently they had used the tool over the past month (1) to look for information and (2) to record information (never = 0, once = 1, weekly = 4, or daily = 28). Following each appointment, patients completed five subscales of the validated Prenatal Interpersonal Processes of Care (PIPC) scale, including elicitation/responsiveness to the patient, explanations of care, empowerment, patient-centered decision making, and emotional support [12]. Responses to each item were transformed onto a 0 (negative perception) to 100 (positive perception) scale, and items are averaged to create subscales.
Research has shown that mobile applications provide a powerful alternative to traditional paper diaries; however, little data exists in comparing apps to the traditional mode of paper as a patient education and engagement tool in the clinical setting. This study was designed to compare the effectiveness of a mobile app versus a spiral-notebook guide throughout prenatal care.
This randomized (n = 173) controlled pilot was conducted at an East Coast community hospital. Chi-square and repeated-measures analysis of variance was used to test intervention effects in the sample of 127 pregnant mothers who completed their prenatal care in the healthcare system.
Patients who were distributed the mobile application used the tool to record information about pregnancy more frequently (p = .04) and developed greater patient activation (p = .02) than patients who were distributed notebooks. No difference was detected on interpersonal clinical communication.
A mobile application successfully activated a patient population in which self-management is a critical factor.
This study shows that mobile apps can prompt greater use and result in more activated patients. Findings may be translated to other patient populations who receive recurring care for chronic disease.
A provoking choice-Swedish women's experiences of reactions to their plans to give birth at home
2012, Women and Birth
Citation Excerpt :
Negatively loaded comments concerning the birthing choice and subsequent risks can influence a woman's mental health during pregnancy29 and can lead to an increase in hurt feelings and decrease in self-confidence.30 To avoid negativism from both the private sphere and health services, the women in this study sought support from other sources – people they knew to have a positive attitude towards home birth, which was earlier described by Darvill et al.28 and Seefat van Teeffelen et al.31 Pregnant women want to receive objective information from the midwife, in a pleasant atmosphere, and they want to make their own choices.31–33 Feeling alienated, thwarted, and threatened because of their home birth choice gives women a sense of guilt, as described by Viisainen.11
The home birth rate in Sweden is less than 1 in 1000, and home birth is not included within the health care system. This study describes women's experiences concerning reactions to their decision to give birth at home.
A nationwide survey (SHE – Swedish Homebirth Experience) in Sweden was conducted between 1992 and 2005 whereas 735 women had given birth to 1038 children. Of 1038 questionnaires 1025 were returned.
In the questionnaires an open-ended question asked women to report their experience of reactions to their decision to give birth at home The question was answered by 594 women, and data were analysed using content analysis.
The analysis yielded one overarching theme; “To be faced with fear for life and death” including being exposed to reactions about risks. This describes attitudes of professionals and family towards life and death and suggests perceptions of risk and fear of unexpected events. Four main categories were identified; Seen as an irresponsible person, Met with emotional arguments, Exposed to persuasion and Alienation.
Women who plan for a home birth were confronted with negative attitudes and persuasion to make them change their mind. This made them feel alienated, and they searched for support among like-minded. Negative attitudes from health care professionals may erode their confidence in conventional health services and turn them towards other options.
Women who want to give birth at home should be given evidence-based information about risks and benefits. Enhanced knowledge among public and professionals about home births would improve the options for respectful encounters.
Early-life origins of disparities in chronic diseases among Indigenous youth: Pathways to recovering health disparities from intergenerational trauma
2019, Journal of Developmental Origins of Health and Disease

View all citing articles on Scopus

Dr. Wong’s research focuses on psychometric evaluation of measures across diverse populations and examining the determinants of health disparities.

Dr. Korenbrot’s research focuses on developing evidence for effective health policies to improve health of low-income families of diverse racial and ethnic groups by analyzing access, quality and costs of perinatal health care.

Dr. Stewart’s research focuses on methodological issues in understanding and reducing health disparities.

View full text

Consumer assessment of the quality of interpersonal processes of prenatal care among ethnically diverse low-income women: Development of a new measure

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Sample and procedures

Results

Discussion

Conclusion

Acknowledgements

Social Science and Medicine

American Journal of Obstetrics and Gynecology

Social Science and Medicine

Women’s Health Issues

Obstetrics and Gynecology

Obstetrics and Gynecology

Patient Education Counseling

Patient and physician characteristics associated with perceived quality of care

Family Practice Research Journal

Translationapplication and research

999 birth cohort file

The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement

British Medical Journal

Patient satisfaction as an indicator of quality care

Inquiry

Patient-provider communicationeffect of race/ethnicity on process and outcomes of healthcare

Unequal treatmentrole of social and psychological research in medicine

Differences in patient-reported processes and outcomes between men and women with myocardial infarction

Journal of General Internal Medicine

Racial and ethnic disparities in perceptions of physician style and trust

Archives of Family Medicine

Surveying consumer satisfaction to assess managed-care qualitycurrent practices

Health Care Financing and Review

Patients’ participation in medical careeffects of blood sugar control and quality of life in diabetes

Journal of General Internal Medicine

Health care characteristics associated with women’s satisfaction with prenatal care

Medical Care

Comprehension of quality care indicatorsdifferences among privately insured, publicly insured, and uninsured

Health Care Financing and Review

Assessing the effects of physician-patient interactions on the outcomes of chronic disease

Medical Care

Quality management practices in Medicaid managed carea national survey of Medicaid and commercial health plans participating in the Medicaid program

Journal of the American Medical Association