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Introduction

Improve axxes to, and untilization of, prenatal care is an integral public health

invitiative. The use of regular and timely prenatal care is highly associated with

improve birth out comes and maternal health. Women who attend early and

adequate prenalat visits are less likely to give birth to an infant with low birth

weight or suffer from maternal or fetal death (Amini, Catalno, & Amnn, 1996;

Brett, Schoendorf, & Kiely, 1994; Vintzileos, Anath, Smulian, Scorza, &

Knuppel, 2002). Insurance or financial issues, as well as demographic factors such

as maternal age, parity, and transportation are commonly referenced as key

barriers to receiving prenatal care. For example, physician attitude, interaction

style, and concern for patient satisfaction with the medical encounter have all been

attributed to women’s willingness to attend prenatal care visits. (Handler,

Rosenberg, Raube, & Kelley, 1998; Raube, Handler, & Rosenberg, 1998).

Prenatal care is often the first time a women uses the health care system as an

adult. Her experiences as a health care user during this period in her life are likely

to shape her opinions and attitudes about future health care use (Paneth,

Wallenstein, Kiely, & Susser, 1982). The perinatal period is an ideal time to

provide education to a woman and her family about preventive health care

(Racine, Joyce, & Grossman, 1992). However, a poor experience during this time

of her life is as equally likely to ensure a woman has a reduced sense of value

about prenatal health care and the health care system, in general (Hickson et al.,

1995; Chassin & Galvin, 1998). In an effort to address the discrepancies between

physicians’ perceptions of the health care they offer and women’s perceptions of
the health care they receive, the present study aims to educate obstetricians about

the impact their services and actions, or inactions, can have on women’s prenatal

care experiences.

Background and Rationale of the Photo Essay

The National Friendly Access program is a community-based participatory

initiative in four communities in the United States that seeks to improve access

and utilization to quality perinatal and pediatric services for the traditionally

underserved. The program began in 2000 at the University of South Florida,

Lawton and Rhea Chiles Center for Healthy Mothers and Babies (LRCC), in

response to quantitative state health department data about our state’s poor birth

outcomes among low-income and minority women.

Dr. Mahan and Dee Jeffers, on behalf of the LRCC, mailed copies of the

focus group reports to physicians who were participating in a local initiative and

results were discussed during a regularly scheduled meeting. The response from

physicians in attendance was negative. Physicians attempted to quantify the

results by asking, “How many women said this?” and personalized by asking,

“Were these my patients?” Attempts to generate initiatives to further examine the

cognitive barriers expressed by the women in the focus groups did not come to

fruition. Physicians said they were “just too busy” to pay attention to women who

did not value the services they offered. Drs. Quinn, Albrecht, Mahan and Ms.

Jeffers, who were developing the research agenda for the Friendly Access

program, believed the findings from the focus groups were too important to

discount or ignore. However, knowing how difficult it is to gain the attention of


health professionals, particularly obstetricians and their staff, the researchers knew

they would have to take a distinctive approach if they were to be successful in this

task.

Methode

Low-income women, who were to deliver or had recently delivered in a

public hospital in an urban area of West Florida, were approached to participate in

the study. They represented women who qualified for and agreed to receive social

and mental health services through the Federal Healthy Start Program, a program

that identifies women at-risk for an adverse pregnancy outcome due to

psychosocial and medical factors. This study was approved by the University of

South Florida’s Institutional Review Board. Nineteen of the 25 eligible women

consented to telling their stories and being photographed. Two woman

experienced tragic outcomes, a stillbirth and neonatal death due to prematurity,

and decided not to participate. The result was eight completed interviews with

three depicted in this article. These three women represent the range of

experiences of a low-income patient in the community. Each woman who

participated in the project received at least five 8 X 10 prints from the images

produced during her interview.

Discussion

Furthermore, whereas many of the issues identified by the women in the project

mirror concerns that have been identified in previous studies, the narratives of the

photo essay provide something deeper. They provide an opportunity for women,

as consumers, to expand their descriptions of their prenatal and delivery


experience. They also create a context for health care providers to understand the

relevance of their experiences. For example, waiting for several hours for an

appointment could be a high source of dissatisfaction to a woman who is

concerned about a problem with the pregnancy and anxious to discuss it with

someone. Nonetheless, given the findings from the study, it seems the photo essay

is an effective tool for capturing the attention of physicians and to get them

thinking about how patients receive and perceive prenatal services.

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