Enhancing the Patient-Provider Relationship in the Provision of Prenatal Care to Women with Low Income

Prenatal care is valuable for women who are at risk of poor birth outcomes due to psychosocial vulnerabilities, including poverty. It is, however, well established that women with low income receive less prenatal care than women of higher socioeconomic status. The patient-provider relationship is an aspect of quality care that mediates the relationship between service provision and equitable care for socially vulnerable populations. There is a dearth of literature that examines how provider characteristics influence the use of prenatal care or interventions to improve access by improving the quality of patient-provider relationships. This gap persists, despite evidence that difficulties in interactions between providers and patient with low income are a barrier to care. This research employed pragmatic action research to engage patients and providers of a community health clinic in articulating practices to enhance relationships between women with low income and prenatal care providers. Pragmatic AR is a cyclical process of data collection and analysis designed to address a community concern and in which knowledge is expressed, analyzed, and tested by participants. The research aims were threefold: (1) to identify critical events in relationships between women with low income and prenatal care providers; (2) to have patients develop vignettes depicting critical events in prenatal care encounters and discussion points to facilitate dialogue about these; (3) to have health care providers and patients use the vignettes and discussion points to identify and evaluate practices to improve the quality of patient-provider relationships. The patient generated vignettes illustrated difficulties associated with judgment and patient involvement with Child and Family Services (CFS). Participant generated management strategies centered on practices for the delivery of non-judgmental care, assessing and communicating about risk, preparing patients for possible CFS involvement, and improving continuity of care. Development of strategies for management of critical events in relationships between patients and provider is a first step towards addressing inequitable access to services and health outcomes. Use of pragmatic AR, which incorporated strategies for patient engagement, has resulted in the development of strategies that are relevant to patients and providers, increasing the uptake of findings.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Educational Psychology

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2016

Author dc:creator

• THOMPSON, CARMEN

Advisor dc:contributor.advisor

• Cairns, Sharon

Committee members dc:contributor.committeemember

• RAMSDEN, VIVIAN
• Steeves, Phyllis
• DRUMMOND, NEIL
• Strong, Tom
• DAHLKE, RITA

• Obstetrics and Gynecology

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

eng

DOI

http://dx.doi.org/10.11575/PRISM/25909

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:11023/2953