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Incentives enhance postpartum compliance among adolescent prenatal patients
C Stevens-Simon1, P O'Connor, K Bassford
1Division of Adolescent Medicine, School of Nursing, University of Colorado Health Science Center, Denver.
Insights
Offering incentives significantly improved postpartum appointment compliance among adolescent mothers. This suggests healthcare providers should consider incentives, particularly for high-risk groups, to enhance postpartum care adherence.
Area of Science:
- Obstetrics and Gynecology
- Adolescent Health
- Public Health Interventions
Background:
- Postpartum appointment compliance is crucial for maternal and infant health.
- Adolescent mothers face unique challenges in accessing postpartum care.
- Incentives are being explored as a strategy to improve healthcare adherence.
Purpose of the Study:
- To evaluate the effectiveness of incentives in enhancing postpartum appointment compliance among adolescent mothers.
- To identify factors associated with improved postpartum care adherence in this population.
Main Methods:
- A randomized controlled trial involving 240 low-income, multiracial adolescents (12-19 years old) at 34 weeks gestation.
- Participants were randomized into an incentive group (offered a 'Cuddler' gift) and a non-incentive group.
- Compliance with postpartum examinations within 12 weeks of delivery was compared using statistical analyses (t-tests, chi-square, logistic regression).
Main Results:
- Overall, 73% of participants attended a postpartum examination.
- The incentive group showed significantly higher compliance (82.4%) compared to the non-incentive group (65.2%) (p = .003).
- Primiparity, adherence to prenatal care, and school enrollment were also significant predictors of postpartum compliance.
Conclusions:
- Offering a tangible incentive significantly increased postpartum appointment attendance among adolescents in a specialized maternity program.
- Healthcare providers should consider implementing postpartum incentives, especially for multiparous, out-of-school, or prenatally non-compliant adolescents.
- Incentives represent a potentially effective strategy to improve postpartum care adherence in vulnerable adolescent populations.
Objective:
To test the hypothesis that incentives enhance compliance with postpartum appointments.
Method:
We studied a multiracial group of 240, poor, 12-to-19 year olds. At 34 weeks gestation consecutively enrolled patients were randomized to incentive and non-incentive groups. Patients in the incentive group were told that they would receive a Gerry "Cuddler" if they returned for an examination within 12 weeks of delivery. The groups were compared with Student's t-tests and chi-square and logistic regression analyses.
Results:
We found no significant group differences in age, race, Medicaid status, gravidity, parity, the timing of the first prenatal visit, compliance with prenatal appointments, or well-baby care site. One hundred and seventy-five (73%) of the 240 patients returned for a postpartum examination. Patients randomized to the incentive group were significantly more likely to return for an examination within 12 weeks of delivery (82.4% vs. 65.2%, chi 2 = 9.0; p = .003). The logistic regression analysis revealed that in addition to membership in the incentive group, three characteristics were significantly associated with postpartum compliance: primiparity, compliance with prenatal care, and school enrollment.
Conclusions:
Among adolescents who obtained prenatal care in a multidisciplinary adolescent-oriented maternity program, the offer of an incentive significantly improved compliance with the 6-week postpartum appointment. Since other factors associated with improved postpartum compliance are less amenable to change we recommend that health care providers consider offering a postpartum incentive, especially to their multiparous adolescent patients who are not enrolled in school and/or are non-compliant with prenatal appointments.