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Increasing Prenatal Care Compliance in At-Risk Black Women: Findings from a RCT of Patient Navigation and Behavioral
Dace S Svikis1, Sydney S Kelpin2, Lori Keyser-Marcus3
1Department of Psychology and Institute for Women's Health, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA. dssvikis@vcu.edu.
Insights
Patient navigation and behavioral incentives improved postpartum visit attendance for at-risk Black mothers, though prenatal care and infant outcomes showed no significant differences. This intervention shows promise for reducing health disparities.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Disparities
Background:
- Infant mortality is a significant public health issue in the USA, with Black women and infants disproportionately affected.
- Inadequate prenatal care is linked to increased risks of prematurity, stillbirth, neonatal loss, and infant death.
- Addressing these disparities requires effective interventions during pregnancy and postpartum.
Purpose of the Study:
- To evaluate the impact of patient navigation and behavioral incentives on prenatal care attendance and maternal/infant outcomes for at-risk Black pregnant women.
- To determine if a combined intervention could improve adherence to prenatal care guidelines and reduce adverse outcomes.
- To explore the effectiveness of a novel intervention in mitigating health disparities.
Main Methods:
- 150 at-risk Black pregnant women were randomized into a patient navigation + behavioral incentives (PNBI) group or an assessment + standard care (ASC) control group.
- Participants were followed throughout pregnancy and for 12 weeks postpartum.
- Intention-to-treat and per-protocol analyses were used for group comparisons.
Main Results:
- No significant differences were observed in the number of prenatal care visits between the PNBI and ASC groups (averaging 9.3 and 8.9 visits, respectively).
- Maternal and infant outcomes did not differ significantly between the groups.
- The PNBI group demonstrated significantly higher attendance at postpartum visits compared to the ASC group (p = 0.002).
Conclusions:
- While prenatal care attendance and infant outcomes were not improved, the intervention effectively increased postpartum visit attendance.
- Findings suggest patient navigation and behavioral incentives may be valuable for improving postpartum care engagement.
- This approach holds potential for reducing health disparities in maternal and infant outcomes, particularly within the redefined fourth-trimester postpartum period.
Background:
In the USA, infant mortality remains a major public health concern, particularly for Black women and their infants who continue to experience disproportionately high mortality rates. Prenatal care is a key determinant of infant health, with inadequate prenatal care increasing risk for prematurity, stillbirth, neonatal loss, and infant death. The aim of the present study was to determine if concurrent delivery of patient navigation and behavioral incentives to at-risk Black pregnant women could improve prenatal care attendance and associated maternal and infant outcomes.
Methods:
Participants were 150 Black pregnant women recruited at first prenatal visit and screening at risk for adverse maternal and infant outcomes. Women were randomized to either the patient navigation + behavioral incentives intervention (PNBI) or assessment + standard care control (ASC) group. All were followed throughout pregnancy and 12-week postpartum. Group comparisons were made using intention-to-treat and per-protocol sensitivity analyses.
Results:
While no group differences were found in prenatal care visits, the average number of visits for both groups (9.3 for PNBI and 8.9 for ASC) approached the American College of Obstetricians and Gynecologists (ACOG) recommended guidelines. There were also no group differences in maternal and infant outcomes. Both intention-to-treat and per-protocol sensitivity analyses, however, consistently found PNBI women attended more postpartum visits than ASC controls (p = 0.002).
Conclusions:
Given ACOG's redefining of the postpartum period as the fourth trimester, study findings suggest PNBI may facilitate prevention and intervention efforts to more successfully reduce health disparities in outcomes for both mother and infant.
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