Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

Abstract

Objective To examine patient perspectives on the experience of preterm birth (PTB) and recommended PTB prevention strategies, focusing on barriers to and facilitators of PTB prevention among low-income women.

Materials and Methods This is an observational study using qualitative methodology to investigate barriers to and facilitators of recurrent PTB prevention among low-income pregnant and postpartum women. Participants were either (1) postpartum from an initial spontaneous PTB, (2) pregnant and receiving 17-α-hydroxyprogesterone caproate (17P), or (3) pregnant or postpartum and declined/discontinued 17P. Participants completed individual interviews, and transcripts were analyzed using modified grounded theory techniques.

Results Of 33 participants, the majority identified as non-Hispanic black (64%) or Hispanic (27%). Four facilitator themes included patient-centered environment, informed choice, social network, and motivation for a healthy family. Barriers included competing demands, resources, skepticism, and normalization. Three considerations, termed subjective influencers, could support women's decisions to use or decline 17P, including personal beliefs about one's body, the role of the fetus, and beliefs on interventionism.

Conclusion The facilitators and barriers identified herein offer insight into the lived experiences of women at a risk of recurrent PTB. Future programs aimed at reducing PTB disparities may benefit from addressing low-income minority women's structural and social determinants of PTB prevention.

Keywords

17-α-hydroxyprogesterone caproate - adherence - preterm birth - patient experiences - health disparities

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