Table 1 Barriers and facilitators related to Use of Prenatal Care (PNC) and suggestions to improve use of PNC by inner-city women: perceptions of health care providers

Barriers

Caregiver qualities

• Too busy/lack of time

• Negative personality characteristics (e.g., rude, judgmental)

Health care system barriers

• Lack of public awareness of PNC services

• Shortage of health care providers who provide PNC

Personal barriers

• Logistical difficulties related to transportation and child care

• Financial problems

• PNC not viewed as a priority, no interest, not seen as important

• Previous negative experience with/distrust of health care system

• Personal pressures (e.g., addictions, intimate partner violence)

• Lack of social support

Program and service characteristics: Inaccessible and/or inconvenient

• Geographic distance

• Lengthy office wait

• Short visits; rushed appointments

• Inflexible or inconvenient hours

Facilitators

Caregiver qualities

• Investing in relationship with client

• Making women feel respected and valued

• Effective communication skills

Caregiver approaches to provision of PNC

• Providing individualized, culturally sensitive care

• Sharing health information with women, answering questions

• Taking time with clients

• Helping women understand importance of PNC

Multidisciplinary approach to PNC

• Referring women to additional services or programs

• Using a team approach to meet women’s needs

Program and service characteristics

• Geographic proximity

• Flexible hours/scheduling

• Self-referral options for clients

• Appointment reminders and follow-up contact

• Expanding community-based clinics

• Assistance with transportation and child care

• Tangible rewards

Suggestions

Make PNC more accessible and convenient

• Establish more community-based PNC clinics

• Ensure closer proximity of PNC

• Provide flexible hours/scheduling

• Create drop-in access to PNC

• Assist with transportation and child care

Motivate women to attend PNC

• Increase public awareness of PNC

• Provide client-focused care

• Explain rationale for PNC during visits

• Offer tangible rewards

Make PNC more responsive to complex needs

• Maintain or enhance Health Baby and Families First programs

• Offer PNC services specific for teens

• Provide substance abuse support for pregnant women

• Expand and promote midwifery services

• Establish “one-stop shops” within a multidisciplinary environment