A Mixed-Methods Evaluation of a Mobile Prenatal Care Delivery Program to Understand Factors to Appointment Adherence

Abstract Information:

Background: In the U.S., there are significant racial and socioeconomic disparities in engagement with prenatal care necessitating investigation into the systemic barriers to adherence. OhioHealth Wellness on Wheels Women's Health (WOW-WH) WOW-WH is a mobile health program that started in 1993 to ensure all women, especially pregnant teens living in urban zip codes in Columbus, Ohio have access to care. After 30 years, WOW-WH still provides comprehensive prenatal and postpartum care, health education, psychosocial counseling, assessment of social determinants of health, and community referrals to pregnant women in low-income areas of Central Ohio. The overall goal of WOW-WH is to provide exceptional care for women regardless of ability to pay. Evaluating patient adherence in this mobile prenatal care program is instrumental to addressing disparities in prenatal care delivery at large and promotes health equity.

Methods: The study used a mixed-methods approach to conduct a process and outcome evaluation of the WOW-WH mobile clinic’s no-show rates as compared to two OhioHealth fixed-site clinics. Electronic medical record (EMR) data was accessed to assess clinic attendance. Seven focus groups were conducted at the mobile and fixed site clinics with patients (n=4) and providers/staff (n=3). The Practical, Robust Implementation and Sustainability Model (PRISM), an implementation science framework, guided qualitative data collection to consider both individual characteristics of participation in the clinic as well as external context in which it operates. Qualitative findings were categorized into the PRISM constructs using a deductive approach, allowing consideration of multi-level factors. A two-sample independent t-test evaluated no-show rates at WOW-WH mobile and fixed-site clinics.

Results: The WOW-WH mobile site had significantly (p < 0.001) lower no-show rates (6%) than fixed-site clinics (8% and 12% at two different fixed-site clinics). Major themes that emerged according to PRISM constructs included (a) the need for improved central scheduling procedures (Intervention Characteristics – Organizational Perspective), (b) that the mobile clinic provided exceptional wraparound care and services to patients and facilitated relationships (Intervention Characteristics – Patient Perspective), and (c) that the mobile clinic allows women to access care they otherwise wouldn’t be able to access because of barriers such as transportation (External Environment). Discussion/Implications: The evaluation found that WOW-WH’s mobile prenatal care delivery promotes greater adherence to prenatal care appointments compared to fixed-site clinics. The qualitative data collection yielded insights to appointment adherence that would not have been otherwise understood if only looking at EMR data and quantitative findings. The evaluation of the WOW-WH mobile sites compared to fixed-site clinics, and engagement of patients and staff from both, resulted in perspectives of various stakeholder voices to lend insight to the barriers and facilitators to prenatal care in Ohio. PRISM allowed triangulation of the mixed-methods findings into actionable recommendations for the health system in order to enhance mobile health care delivery. This mobile health women’s clinic has been operating for over 30 years with minimal staff turnover, strong patient connection and long lasting trustworthiness. Understanding best practices for successful interventions and services is essential for replication to other areas and for program redesign and development.