Barriers to Prenatal Care in Low-income Women

Abstract

The purposes of this study were to: investigate barriers to prenatal care, both structural and psychosocial; test the Pender Health Promotion Model and the Triandis Model of Social Behavior to determine their effectiveness in predicting utilization of prenatal care; and document behaviors women perform during pregnancy to stay healthy. The sample consisted of 207 low-income pregnant women recruited from a public clinic at their first prenatal visit.

The Pender Model was operationalized with the following instruments: the Laffrey Health Conception Scale, Wellness Subscale; the Multidimensional Health Locus of Control Scale, Form A, Internal Subscale; the Krondak Barriers and Benefits to Prenatal Care Scale; the Personal Competence Scale; the Value Survey; a single item measuring perceived health status; and researcher-developed scales measuring interpersonal factors, behavioral factors, situational factors, and demographic factors. The Triandis Model was operationalized by researcher-developed scales measuring the following constructs: behavioral intention, affect, facilitating conditions, norms, self-concept, role perceptions, habit, and perceived consequences. Utilization of prenatal care was measured using Kotelchuck's Adequacy of Prenatal Care Utilization Index. In addition, two open-ended questions regarding the woman's healthy behaviors practiced during pregnancy and her sources of health information were asked.

Path analysis was used in model testing. The Pender model was significant in the prediction of prenatal care adequacy (p $<$.02, R2 =.05), with only the concept of perceived benefits as a significant predictor (B = $-$.212). The Triandis model was significant (p $<$.0002, R2 =.09), with behavioral intention (B = $-$.188) and facilitating conditions (B = $-$.205) as significant predictors. Concepts in the Triandis model predicted 40% of the variance in behavioral intention to obtain prenatal care, but intention did not predict prenatal care utilization.

Responses to open-ended questions identified food-related behaviors as the most common health behavior in pregnancy, and family members as the most common source of information about healthy behaviors in pregnancy. What motivates women to use prenatal care remains unclear. Personal, cultural, and environmental factors should be included in proposed models to predict prenatal care utilization.