TY - JOUR
T1 - 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
AU - McCue, Kelly
AU - Sabo, Samantha
AU - Wightman, Patrick
AU - Butler, Matthew
AU - Pilling, Vern
AU - Jiménez, Dulce
AU - Annorbah, Rebecca
AU - Rumann, Sara
N1 - Funding Information:
This work is supported through an inter-agency contract from ADHS. Funding for the study is provided by the Arizona State Lottery through ADHS for the period of July 1, 2017-June 30, 2022. Health Resources Services Administration (HRSA) Maternal, Infant, Early Childhood Home Visiting (MIECHV) provided 17 months of additional federal funding through ADHS during the study period.
Funding Information:
We would like to acknowledge several offices at the Arizona Department of Health Services (ADHS) for their support and commitment to this study: the Bureau of Women and Children’s Heath, the Health Start Program, the Bureau of Public Health Statistics, the Immunization Program, and Vital Statistics. We also acknowledge the members of the ADHS Human Subjects Review Board for continued guidance in data sharing and data protection and security. We share our gratitude and admiration to the hundreds of Health Start CHWs who work tirelessly to improve maternal and child health equity in Arizona.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Home visiting
KW - community health worker
KW - prenatal care
KW - propensity score matching
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U2 - 10.1007/s10995-022-03506-2
DO - 10.1007/s10995-022-03506-2
M3 - Article
C2 - 36269498
AN - SCOPUS:85140301573
SN - 1092-7875
VL - 26
SP - 2485
EP - 2495
JO - Maternal and Child Health Journal
JF - Maternal and Child Health Journal
IS - 12
ER -