Introduction: Despite improvement initiatives, patient non-adherence remains an issue in healthcare. Patients with high-risk pregnancies require more frequent monitoring to reduce complications. This study aims to better understand visit non-adherence with high-risk prenatal appointments. We hypothesized that patients’ perceived logistic barriers would be the most prominent determinant of visit non-adherence.
Methods: This study included adult, English speaking patients of the high-risk prenatal clinic at Cooper University Hospital that missed at least one appointment. We completed three, one hour focus groups with seven participants. Constant comparison analysis was used to determine common themes discussed by participants. Axial coding and basic unit descriptors were defined by both facilitators to determine common themes discussed during the focus group sessions.
Results: We identified two main themes in regards to patient visit non-adherence in our population: logistic issues and perceived relationship issues between the patient and the care team. Logistic issues included issues with rescheduling, seeing different providers, parking, wait time and office hours. In regards to patient-care team relationships, subjects frequently brought up issues with respect, feeling heard by providers, communication and professionalism. All seven patients identified at least one of the five domains of logistic barriers as a concern. Five of the seven participants identified an issue across the four domains of relationship issues.
Discussion: The focus group analysis illustrated recurrent themes of logistic barriers and deficiencies in patient-care team relationships that contributed to high-risk prenatal visit non-adherence. A follow-up survey study is necessary to quantitatively assess the most prominent reasons for visit non-adherence based on the themes identified in our study.
Keywords: High-Risk Prenatal Clinic, Appointment Adherence, Health Behaviors Model, Theory of Planned Behavior, Focus Group Analysis
Nicolais-Julian, MD, Olivia; Monaghan, MD, Michael; and Mitchell-Williams MD, PhD, Jocelyn
"Behavioral Health Models to Understand High-Risk Prenatal Patient Adherence to Visit Schedule in Camden,"
Cooper Rowan Medical Journal: Vol. 4:
1, Article 9.
Available at: https://rdw.rowan.edu/crjcsm/vol4/iss1/9
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