Purpose: Prenatal care (PNC) is the healthcare service most often provided to women of childbearing age throughout the world. Poorly understood and defined, based on culture, and expensive for any healthcare system, PNC remains a target for change and improvement. The purpose of this cross-national qualitative research study using narrative inquiry methods was to explore consumer perspectives of individual health and routine PNC in the USA and Iceland. Methods: A purposive sampling technique was used to identify study participants (n = 32) from the United States (n = 16) and Iceland (n = 16). Data were collected via a semi structured interview which included demographic questions. Results: Content analysis processes were used to analyze the transcribed narratives to identify common conceptual themes. Subsequently, the narratives of the women from the two nations were compared to identify cultural variations about PNC. In respect to the findings, demographically the two groups were similar. Respondents from both nations preferred a more supportive role from PNC providers with adequate time to explore important personal concerns and less emphasis on monitoring weight gain during the pregnancy. Variations between the two groups related to the health care delivery system iv of the nation in which respondents resided. These findings have the potential for expanding the definition of PNC to include consumer perspectives. Discussion/Implication: Additional research is needed with other groups of women to validate, clarify and expand identified themes, as they may improve PNC, and ultimately, perinatal outcomes. Improving PNC holds the promise of improving infant mortality while at the same time reducing healthcare expenditures for countries around the world.

The study evaluates the effectiveness of a pregnancy intervention model (PIM) developed to improve first trimester prenatal care utilization in a population of 2,694 low-income Medicaid women. Engagement in prenatal care is critical before prenatal care can occur. Early initiation of prenatal care is important for low income pregnant women at risk for poor birth outcomes and the Medicaid managed care organizations that enroll them. Once identified and enrolled the health plan utilization medical management staff assessed these women for a myriad of high risk and socially detrimental behaviors in order to facilitate, in a sensitive manner, their access to drug treatment or any needed service. Interventions included a real time identification, reporting, incentive model using medical informatics to supplement existing clinical based assessment of high risk pregnant women and nursing care coordination that included outreach, enrollment assistance, support services, interagency coordination, home visits, transportation and medical home assignment. A difference was found in the utilization of first trimester prenatal care visits for all women who conceived after the intervention compared to those who conceived prior to the intervention date. A difference was also noted in the "no prenatal care" category due a decrease in the number of women who did not receive prenatal care. PIM appears to be a cost effective, simple solution to a real world problem. / Graduation date: 2005