Evidence Tools
MCHbest. Early Prenatal Care.

Overview. Increasing early access to prenatal care for birthing women should include a multi-faceted approach that may include services that are free or provided on a sliding scale, are patient-centered, and provide wrap-around services. (social workers, insurance navigators, free medication and lab work, transportation, home visits, weekend clinic hours, child care, and postpartum support).[1-4] Identifying the structural and interpersonal systems at play and which interventions for low-SES are appropriate can improve the use of early PNC (additional appointments, extended time with healthcare providers, and additional supports including transportation, child care, peer support, and a welcoming, positive physical space).[2,4]. When women are informed of their risk conditions and behaviors and are provided with education and information, they may be more likely to access care.[2] Understanding factors associated with bias can improve satisfaction and attendance among all populations.[5] Providing just-in-time feedback and patient care surveys may also shed light on perceived differences among patients in care received, especially among young patients.[5] California uses the Person-Centered Prenatal Care and Person-Centered Maternity Care validated scales to better understand how mothers experience their care.[5] The Healthy Family Initiative. (Texas) uses a community-based participatory approach. (CBPR) by engaging “…stakeholders to identify, design, and adapt strategies to address community-identified priorities.” The importance of strengthening home visiting programs. (like NFP), integrating healthcare providers and CHW including CHW and nurse home visitors who represent the communities, and addressing the structural challenges of populations that need additional support in Texas. Research has found that training healthcare providers to provide responsive and humble healthcare for all populations, such as may help to ensure access to early prenatal care.[7] Healthcare providers can engage in community-provider partnerships, which may increase trust and reduce misunderstandings between patients and providers.[7]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

• Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
• Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
• Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).