Impact of a Community Health Worker (CHW) Home Visiting Intervention on Any and Adequate Prenatal Care Among Ethno-Racially Diverse Pregnant Women of the US Southwest

Kelly McCue, Samantha Sabo, Patrick Wightman, Matthew Butler, Vern Pilling, Dulce Jiménez, Rebecca Annorbah, Sara Rumann

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objectives: Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. Methods: We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006–2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. Results: Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02–1.50) and adequate (OR 1.08, 95%CI 1.01–1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07–4.60), primipara women (OR 1.64, 95%CI 1.13–2.38), teens (OR 1.58, 95%CI 1.02–2.45), women in rural border counties (OR 1.45, 95%CI 1.05–1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11–1.55), women in rural border counties (OR 1.18, 95%CI 1.05–1.33), primipara women (OR 1.18, 95%CI 1.05–1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27). Conclusions for Practice:: A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.

Original languageEnglish (US)
Pages (from-to)2485-2495
Number of pages11
JournalMaternal and Child Health Journal
Volume26
Issue number12
DOIs
StatePublished - Dec 2022

Keywords

  • Home visiting
  • community health worker
  • prenatal care
  • propensity score matching

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Epidemiology
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health

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