Maternal and Child Health Journal

, Volume 9, Issue 2, pp 135–149 | Cite as

Health Promotion and Psychosocial Services and Women’s Assessments of Interpersonal Prenatal Care in Medicaid Managed Care

  • Carol C. Korenbrot
  • Sabrina T. Wong
  • Anita L. Stewart


Objectives: If prenatal health promotion and psychosocial support services are to remain accessible to Medicaid eligible women, evidence is needed as to whether the services improve care and benefit women in ways that matter to health plans. The aims of this study are to determine whether prenatal health promotion and psychosocial services are associated with better interpersonal care and greater satisfaction with care; and whether the effects on interpersonal care help explain satisfaction with care. Research Design: A telephone survey of 363 African American, Latina (US and nonUS-born) and White women receiving prenatal care in four Medicaid public health plans in California in 2001. Multivariate regression analyses were done with adjustments for potentially confounding variables. Measures: Independent variables included dichotomous variables for health promotion advice (five separate areas) and composite scales for psychosocial assessment (six areas combined). Dependent variables included satisfaction with care, and indices for interpersonal care (communication, decision-making, and interpersonal style). Results: Women who report receiving health promotion or psychosocial services also report receiving better interpersonal care and rate their satisfaction with care higher. Receiving either type of support service is associated with higher quality communication, decision-making and interpersonal style. The effects of the support services on satisfaction are, in turn, explained by the effects on interpersonal care. Conclusions: Prenatal health promotion and psychosocial services have associated benefits to enrollees that should matter to Medicaid health plans and their providers.


health promotion psychosocial prenatal care interpersonal care satisfaction with care medicaid managed care race/ethnicity communication decision-making quality care enhanced prenatal care 


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  1. 1.
    McLaughlin FJ, Altemeier WA, Christensen MJ, Sherrod KB, Dietrich MS, Stern DT. Randomized trial of comprehensive prenatal care for low-income women: Effect on infant birth weight. Pediatrics 1992;89:128–32.PubMedGoogle Scholar
  2. 2.
    Fuentes-Afflick E, Korenbrot CC, Greene J. Ethnic disparity in the performance of prenatal nutrition risk assessment among Medicaid-eligible women. Public Health Rep 1995;110:764–73.PubMedGoogle Scholar
  3. 3.
    Reichman NE, Florio, MJ. Effects of enriched prenatal care services on Medicaid birth outcomes in New Jersey. J Health Econ 1996;15 455–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Kotelchuck M, Kogan MD, Alexander GR, Jack BW. The influence of site of care on the content of prenatal care for low-income women. Matern Child Health J 1997;1:25–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Baldwin LM, Larson EH, Connell FA, Nordlund D, Cain KC, Cawthon ML, Byrns P, Rosenblatt RA. The effect of expanding Medicaid prenatal services on birth outcomes. Am J Public Health 1998;88:1623–9.PubMedGoogle Scholar
  6. 6.
    Homan RK, Korenbrot CC. Explaining variation in birth outcomes of Medicaid-eligible women with variation in the adequacy of prenatal support services. Med Care 1998;36:190–201.CrossRefPubMedGoogle Scholar
  7. 7.
    Newschaffer CJ, Cocroft J, Hauck WW, Fanning T, Turner BJ. Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus. Obstet Gynecol 1998;91:885–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Newschaffer CJ, Zhang D, Hauck WW, Fanning T, Turner BJ. Effect of enhanced prenatal and HIV-focused services for pregnant women who are infected by human immunodeficiency virus on emergency department use. Med Care 1999;37:1308–19.CrossRefPubMedGoogle Scholar
  9. 9.
    Klerman LV, Ramey SL, Goldenberg RL, Marbury S, Hou J, Cliver SP. A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. Am J Public Health 2001;91:105–11.PubMedGoogle Scholar
  10. 10.
    Reichman NE, Teitler J. Effects of psychosocial risk factors and prenatal interventions on birth weight: evidence from New Jersey’s HealthStart program. Perspect Sex Reprod Health 2003;35:130–7.PubMedGoogle Scholar
  11. 11.
    U.S. Public Health Service (PHS). Caring for our future: The content of prenatal care. Washington DC: Public Health Service, 1989.Google Scholar
  12. 12.
    Woolf SH, Jonas S, Lawrence RS. Health promotion and disease prevention in clinical practice. Baltimore MD: Williams and Wilkins, 1996.Google Scholar
  13. 13.
    American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG). Guidelines for perinatal care. 4th edn. Washington DC: American College of Obstetricians and Gynecologists, 1997.Google Scholar
  14. 14.
    Paine LL, Garceau LM. Health behaviors during pregnancy: Risks and interventions. McCormick, M. C. and Siegel, J. E. Prenatal care: Effectiveness and implementation. Cambridge UK: Cambridge University Press, 1999, pp. 33–62.Google Scholar
  15. 15.
    Kaiser Commission on Medicaid and the Uninsured. Medicaid: Fiscal challenges to coverage. August 2003. Available at:; Viewed August 19, 2003.
  16. 16.
    U.S. General Accounting Office (GAO). Medicaid prenatal care: States improve access and enhance services, but face new challenges. Washington DC: U.S. General Accounting Office (GAO/HEHS-94-152BR), 1994.Google Scholar
  17. 17.
    Minkovitz CS, Duggan AK, Fox MH, Wilson MH. Use of social services by pregnant Medicaid eligible women in Baltimore. Matern Child Health J 1999;3:117–27.CrossRefPubMedGoogle Scholar
  18. 18.
    Minkovitz CS, Duggan AK, Wilson MH. Managed care: reimbursement structure, and access to prenatal social services. Women’s Health Issues 1999;9:231–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Alexander GR, Hulsey TC, Foley K, Keller E, Cairns K. An assessment of the use and impact of ancillary prenatal care services to Medicaid women in managed care. Matern Child Health J 1997;1:139–49.CrossRefPubMedGoogle Scholar
  20. 20.
    Aharony L, Strasser S. Patient satisfaction: What we know about and what we still need to explore. Med Care Rev 1993;50:49–79PubMedGoogle Scholar
  21. 21.
    Cleary PD. The increasing importance of patient surveys. Now that sound methods exist, patient surveys can facilitate improvement. BMJ1999; 319:720–1.PubMedGoogle Scholar
  22. 22.
    Morales LS, Elliott MN, Weech-Maldonado R, Spritzer KL, Hays RD. Differences in CAHPS adult survey reports and ratings by race and ethnicity: An analysis of the National CAHPS benchmarking data 1.0. Health Serv Res 2001;36:595–617.PubMedGoogle Scholar
  23. 23.
    Gold M, Wooldridge J. Surveying consumer satisfaction to assess managed-care quality: current practices. Health Care Financ Rev 1995;16:155–73.PubMedGoogle Scholar
  24. 24.
    Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Serv Res 2003;38:789–808.CrossRefPubMedGoogle Scholar
  25. 25.
    National Center for Education in Maternal and Child Health (NCEMCH). Bright futures: Guidelines for health supervision of infants, children and adolescents, 2nd edn. Georgetown University, National Center for Education in Maternal and Child Health, 2002.Google Scholar
  26. 26.
    Schor EL. Family pediatrics: Report of the Task Force on the Family. Pediatrics2003;11(6 Pt 2):1541–71.Google Scholar
  27. 27.
    Handler A, Rosenberg D, Raube K, Kelley MA. Health care characteristics associated with women’s satisfaction with prenatal care. Med Care 1998;36:679–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Handler A, Rosenberg D, Raube K, Lyons S. Satisfaction and use of prenatal care: Their relationship among African-American women in a large managed care organization. Birth 2003; 30:23–30.CrossRefPubMedGoogle Scholar
  29. 29.
    Handler A, Rosenberg D, Raube K, Lyons S. Prenatal care characteristics and African-American women’s satisfaction with care in a managed care organization Women’s Health Issues 2003; 13:93–103.CrossRefPubMedGoogle Scholar
  30. 30.
    Raube K, Handler A, Rosenberg D. Measuring satisfaction among low-income women: A prenatal care questionnaire. Matern Child Health J 1998; 2:25–33.CrossRefPubMedGoogle Scholar
  31. 31.
    Korenbrot CC. Final Report to the Maternal and Child Health Bureau Grant R40MC00137: assessment of enhanced Prenatal services by women of diverse ethnic groups in medicaid Managed care. Springfield VA: National Technical Information Service, 2003.Google Scholar
  32. 32.
    Wong ST, Korenbrot CC, Stewart AL. Assessment of the quality of interpersonal processes of prenatal care by low income women of diverse race and ethnicity. Women’s Health Issues 2004; 14:118–29.CrossRefPubMedGoogle Scholar
  33. 33.
    Brislin RW. Translation: Application and research. New York NY: Gardner; 1976.Google Scholar
  34. 34.
    Marín G, Marín BV. Research with Hispanic populations. Newbury Park CA: Sage, 1991.Google Scholar
  35. 35.
    California Department of Health Services (CDHS). Steps to take: Comprehensive Perinatal Services Program guidelines. Sacramento CA: Maternal and Child Health Branch, 1997.Google Scholar
  36. 36.
    Institute of Medicine. Nutrition during pregnancy. Washington DC: National Academy Press, National Academy of Sciences, 1990.Google Scholar
  37. 37.
    Nunnally JC, Bernstein IH. Psychometric theory, 3rd edn. New York NY: McGraw-Hill, 1994.Google Scholar
  38. 38.
    Institute of Medicine. Preventing low birth weight. Washington DC: National Academy Press, National Academy of Sciences, 1985.Google Scholar
  39. 39.
    Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures. JAMA 1994;271:1340–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Korenbrot CC, Gill A, Clayson Z, Patterson E. Evaluation of California’s statewide implementation of enhanced perinatal services as Medicaid benefits. Public Health Rep 1995;110:125–33.PubMedGoogle Scholar
  41. 41.
    Alexander GR, Korenbrot CC. The role of prenatal care in preventing low birth weight. Future Child 1995;5:103–20.Google Scholar
  42. 42.
    Blondel B. Social and medical support during pregnancy: An overview of the randomized controlled trials. Prenat Neonat Med 1998;3:29–31.Google Scholar
  43. 43.
    Korenbrot CC, Moss NE. Preconception, prenatal, perinatal and postnatal influences on health. Institute of medicine. Promoting health: Intervention strategies from social and behavioral research.Washington DC: National Academy Press, National Academy of Sciences, 2000:125–69.Google Scholar
  44. 44.
    Institute of Medicine. Assessing potential sources of racial and ethnic disparities in care: The clinical encounter. Unequal Treatment: Confronting Racial and ethnic disparities in healthcare. Washington DC: National Academy Press, National Academy of Sciences, 2002:160–79.Google Scholar
  45. 45.
    Murray-Garcia JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP. Racial and ethnic differences in a patient survey: Patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care 2000;38:300–10.CrossRefPubMedGoogle Scholar
  46. 46.
    Marshall GN, Morales LS, Elliott M, Spritzer K, Hays RD. Confirmatory factor analysis of the Consumer Assessment of Health Plans Study (CAHPS) 1.0 Core Survey. Psychologic Assess 2001;13:216–29.CrossRefGoogle Scholar
  47. 47.
    Carlson MJ, Blustein J, Fiorentino N, Prestianni F. Socioeconomic status and dissatisfaction among HMO enrollees. Med Care 2000;38:508–16.CrossRefPubMedGoogle Scholar
  48. 48.
    Wilkinson DS, Gonzalez-Calvo J. Clients’ perceptions of the value of prenatal psychosocial services. Soc Work Health Care 1999;29:1–12.CrossRefGoogle Scholar
  49. 49.
    Cooper LA, Roter DL. Patient-provider communication: Effect of race ethnicity on process and outcomes of healthcare. In: Institute of Medicine. Unequal treatment: role of social and psychological research in medicine. Washington DC: National Academy Press, National Academy of Sciences, 2002.Google Scholar
  50. 50.
    Drinkard CR, Shatin D, Luo D, Heinen MJ, Hawkins MM, Harmon RG. Healthy pregnancy program in a national managed care organization: Evaluation of satisfaction and health behavior outcomes. Am J Manag Care 2001;7:377–86.PubMedGoogle Scholar
  51. 51.
    Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the patient’s eyes: Understanding and promoting patient-centered care. San Francisco CA: Jossey-Bass, 1993.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Carol C. Korenbrot
    • 1
    • 2
    • 7
  • Sabrina T. Wong
    • 1
    • 3
    • 4
  • Anita L. Stewart
    • 5
    • 6
  1. 1.Institute for Health Policy StudiesUniversity of California San Francisco
  2. 2.Department of Obstetrics, Gynecology and Reproductive Sciences, School of MedicineUniversity of California San FranciscoSan Francisco
  3. 3.Medical Effectiveness Research Center for Diverse PopulationsUniversity of CaliforniaSan Francisco
  4. 4.School of NursingUniversity of British ColumbiaVancouver
  5. 5.Medical Effectiveness Research Center for Diverse PopulationsUniversity of California San Francisco
  6. 6.Institute for Health and Aging, School of NursingUniversity of California San FranciscoSan Francisco
  7. 7.School of MedicineUniversity of California, San FranciscoSan Francisco

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