Health Care Use, Coverage, and Experiences During the Year Prior to Pregnancy in a Primarily Hispanic Population with Low Income: A Descriptive Qualitative Study

• Published in: Journal of midwifery & women's health 2023-09, Vol.68 (5), p.619-626
• Main Authors: Nehme, Eileen K., Patel, Divya A., Cortez, Dagoberto, Morse, Sophie M., Schuessler, Kirkland, Gulbas, Lauren E.
• Format: Article
• Language: English
• Subjects: Autonomy; Birth control; care seeking; Childrens health; Chronic pain; Gallbladder; health care coverage; Health care expenditures; Health care policy; health care utilization; Health education; Health facilities; Health information; Health insurance; Health services utilization; Hispanic; Hispanic people; Infections; Low income groups; Medicaid; Medical personnel; Medical screening; Patient communication; Patient-centered care; Payments; Perinatal; preconception; Pregnancy; preventive health care; Preventive medicine; Sexually transmitted diseases; STD; Stomach; uninsured; Women; Workplaces
• ISSN: 1526-9523; 1542-2011
• DOI: 10.1111/jmwh.13510

Introduction A qualitative picture of the health care experiences prior to pregnancy can inform patient‐centered strategies to optimize preconception health. This study describes health care utilization and experiences and how health care costs were covered in the year prior to pregnancy in a population of primarily Hispanic women with low income. Methods Pregnant participants were recruited from 5 Federally Qualified Health Center clinics. Semistructured interviews included questions about health care in the year prior to pregnancy. Transcripts were analyzed using a thematic approach that integrated deductive and inductive analysis. Results Most participants self‐identified as Hispanic. Just under half were US citizens. All but one were Medicaid or Children's Health Insurance Program Perinatal coverage insurance during pregnancy and relied on a variety of strategies to cover prepregnancy health care costs. Almost all received health care during the year prior to pregnancy. Fewer than half reported an annual preventive visit. Health care needs that led to care‐seeking included a prior pregnancy, chronic depression, contraception, workplace injury, a persistent rash, screening and treatment for sexually transmitted infection, breast pain, stomach pain (leading to gallbladder removal), and kidney infection. The ways in which study participants covered the costs of health care ranged in terms of sources and complexity. Although some participants described stable health care coverage, most reported changes throughout the year as they pieced together various health care coverage programs and out‐of‐pocket payments. When participants did seek health care prior to their current pregnancy, most described the experience in positive terms and focused on health care provider communication quality. Respect of patient autonomy was highly valued. Discussion Women with pregnancy‐related health care coverage accessed care for a wide range of health care needs prior to pregnancy. Health care providers may consider strategies to respectfully introduce preconception care into any visit by an individual who could become pregnant.