Beyond Intentionality: A Latent Class Analysis of Barriers to Prenatal Care in an Explanatory Mixed Methods Study

Objective: Utilizing the Health Care Access Barriers (HCAB) Theoretical Framework, this study examined latent profiles of barriers to prenatal care among pregnant women in Alabama and whether these profiles mediate or moderate the relationship between pregnancy intentionality and early prenatal care initiation. Methods: An explanatory mixed-method design was employed, integrating quantitative analysis of Alabama Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 data (2016-2021) with qualitative insights from expert interviews. Latent class analysis (LCA) identified subgroups based on reported barriers. Multivariable logistic regression assessed the association between pregnancy intentionality and early prenatal care initiation, controlling for covariates. A Firth-penalized multivariable logistic regression model tested interaction effects. Results: Planned pregnancy was associated with higher odds of early prenatal care initiation (OR = 0.78, 95% CI [0.49, 1.23], p = 0.286), though this association was not statistically significant. Barrier profiles did not significantly moderate or mediate the relationship. The interaction term was nonsignificant (OR = 5.19, 95% CI [0.22, 828.94], p = 0.309), and the mediation pathway was also not supported (indirect effect = 0.012, p = 0.518). Expert interviews emphasized ongoing systemic and cognitive barriers that hinder timely access. Conclusions: Although pregnancy intentionality was not a statistically significant predictor of early prenatal care initiation, qualitative findings highlighted persistent barriers that continue to constrain access. These results underscore the need for multilevel strategies to address informational and logistical challenges. Future research should evaluate additional pathways that influence care-seeking behaviors.