Increasing Prenatal Care Compliance in At-Risk Black Women: Findings from a RCT of Patient Navigation and Behavioral Incentives

Abstract

Background

In the USA, infant mortality remains a major public health concern, particularly for Black women and their infants who continue to experience disproportionately high mortality rates. Prenatal care is a key determinant of infant health, with inadequate prenatal care increasing risk for prematurity, stillbirth, neonatal loss, and infant death. The aim of the present study was to determine if concurrent delivery of patient navigation and behavioral incentives to at-risk Black pregnant women could improve prenatal care attendance and associated maternal and infant outcomes.

Methods

Participants were 150 Black pregnant women recruited at first prenatal visit and screening at risk for adverse maternal and infant outcomes. Women were randomized to either the patient navigation + behavioral incentives intervention (PNBI) or assessment + standard care control (ASC) group. All were followed throughout pregnancy and 12-week postpartum. Group comparisons were made using intention-to-treat and per-protocol sensitivity analyses.

Results

While no group differences were found in prenatal care visits, the average number of visits for both groups (9.3 for PNBI and 8.9 for ASC) approached the American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. There were also no group differences in maternal and infant outcomes. Both intention-to-treat and per-protocol sensitivity analyses, however, consistently found PNBI women attended more postpartum visits than ASC controls (p = 0.002).

Conclusions

Given ACOG’s redefining of the postpartum period as the fourth trimester, study findings suggest PNBI may facilitate prevention and intervention efforts to more successfully reduce health disparities in outcomes for both mother and infant.

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Acknowledgments

This study was supported by Cooperative Agreement Number 5U58DP000983 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the sponsors. This article is dedicated to the late Saba Masho, who was devoted to reducing health disparities in maternal and infant outcomes and played a leadership role in the conduct of this research. The authors would like to thank Ervina Baskerville-Allen and Lavon Jones Jiles for their assistance with the patient navigator component of the study.

Funding

This study was supported by Cooperative Agreement Number 5U58DP000983 from the Centers for Disease Control and Prevention.

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Authors

Contributions

Dace S. Svikis, Lori Keyser-Marcus, Diane L. Bishop, Lauretta A. Cathers, Susan Lanni, Nicole Karjane, and Saba W. Masho contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Diane Bishop, Saba Masho, Dace Svikis, Sara Varner, Gabriela Villalobos, Diane Langhorst, and Anna Beth Parlier-Ahmad. Heather Jones contributed to the content of the manuscript, bringing expertise in the study of systemic racism and health disparities. The first draft of the manuscript was written by Dace S. Svikis, Sydney S. Kelpin, and Diane L. Bishop. All authors* read and approved the final manuscripts.

*It should be noted that while Dr. Saba W. Masho played an integral role in project conception, data collection, and analyses and she reviewed early drafts of study findings, she is unable to approve the final manuscript as Dr. Masho passed away on May 28, 2018.

Corresponding author

Correspondence to Dace S. Svikis.

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Ethics Approval

The Institutional Review Board of Virginia Commonwealth University reviewed and approved all study procedures (HM11936).

Consent to Participate

Informed consent was obtained from all participants included in the study, with parental/guardian consent for women under age 18.

Conflicts of Interests

The authors declare that they have no conflicts of interest.

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Svikis, D.S., Kelpin, S.S., Keyser-Marcus, L. et al. Increasing Prenatal Care Compliance in At-Risk Black Women: Findings from a RCT of Patient Navigation and Behavioral Incentives. J. Racial and Ethnic Health Disparities (2021). https://doi.org/10.1007/s40615-021-00995-9

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Keywords

  • Health disparities,
  • Pregnancy,
  • Prenatal care,
  • Patient navigation,
  • Incentives