Understanding perinatal patient's health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Pregnancy Complications, Infectious*/diagnosis ; Pregnancy Complications, Infectious*/prevention & control ; Syphilis*/diagnosis ; Syphilis, Congenital*/diagnosis ; Syphilis, Congenital*/prevention & control; Adolescent ; California ; Child ; Ethnicity ; Female ; Humans ; Louisiana ; Minority Groups ; Pregnancy ; Prenatal Care ; United States

Background: Congenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient's health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting.
Methods: Between May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants' understanding of health disparities and vulnerable populations; perinatal patient's health and prenatal care preferences; and participants' perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment.
Results: Site-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment.
Conclusions: Our findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people's access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.
(© 2022. The Author(s).)

Res Nurs Health. 2006 Oct;29(5):477-88. (PMID: 16977644)
Sex Transm Dis. 2011 Jul;38(7):598-602. (PMID: 21317685)
Clin Obstet Gynecol. 2013 Mar;56(1):173-7. (PMID: 23314723)
BMC Pregnancy Childbirth. 2012 Apr 13;12:29. (PMID: 22502640)
MMWR Morb Mortal Wkly Rep. 2019 Feb 15;68(6):144-148. (PMID: 30763294)
MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. (PMID: 26042815)
MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. (PMID: 34292926)
Clin Trials. 2018 Dec;15(6):557-566. (PMID: 30295050)
JAMA. 2001 Sep 26;286(12):1506-9. (PMID: 11572745)
J Womens Health (Larchmt). 2021 Jul;30(7):920-926. (PMID: 34254848)
MMWR Morb Mortal Wkly Rep. 2020 Jun 05;69(22):661-665. (PMID: 32497029)
Am J Public Health. 2006 Dec;96(12):2113-21. (PMID: 17077411)
Sex Transm Dis. 2018 Jul;45(7):435-441. (PMID: 29465666)
Sex Transm Dis. 2021 Feb 1;48(2):71-78. (PMID: 32925597)
Matern Child Health J. 2013 Oct;17(8):1346-54. (PMID: 23334357)
Clin Obstet Gynecol. 2013 Mar;56(1):178-85. (PMID: 23314722)
Fam Pract Manag. 2019 Jul/Aug;26(4):29-33. (PMID: 31287266)
J Am Med Inform Assoc. 1998 May-Jun;5(3):257-62. (PMID: 9609495)
Infect Dis Obstet Gynecol. 2012;2012:430585. (PMID: 22829747)
Sex Transm Dis. 2018 Jul;45(7):447-451. (PMID: 29465662)
PLoS One. 2021 Apr 1;16(4):e0249419. (PMID: 33793630)
BMC Infect Dis. 2021 Jan 13;21(1):64. (PMID: 33435889)
Pediatr Infect Dis J. 2019 Nov;38(11):1126-1130. (PMID: 31469777)
Eur J Ageing. 2010 Dec;7(4):313-316. (PMID: 21212820)

U380T000199-05-00 United States CC CDC HHS; U380T000199-05-00 United States CC CDC HHS

Keywords: Congenital; Health disparities; Health preferences; Pregnancy; Prenatal care; Qualitative research; Sexually transmitted infection; Syphilis

Date Created: 20220711 Date Completed: 20220713 Latest Revision: 20220716

20250114

PMC9275237

10.1186/s12884-022-04883-w

35818040