title: How health care setting affects prenatal providers' risk reduction practices: a qualitative comparison of settings.
abstract: BACKGROUND
  We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks.
  
  
  METHODS
  We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors.
  
  
  RESULTS
  Practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO.
  
  
  CONCLUSIONS
  Each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings.
authors.affiliation: Division of Behavioral Sciences, Professionalism, and Ethics, University of California San Francisco, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94117, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Gilbert
authors.forename: Karen
authors.initials: K
authors.lastname: Herzig
authors.forename: Dhara
authors.initials: D
authors.lastname: Thakar
authors.forename: Joyce
authors.initials: J
authors.lastname: Viloria
authors.forename: Alyssa
authors.initials: A
authors.lastname: Bogetz
authors.forename: Dale W
authors.initials: DW
authors.lastname: Danley
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.forename: Barbara
authors.initials: B
authors.lastname: Gerbert
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002140:California; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D019966:Substance-Related Disorders / Q000517:prevention & control; D011795:Surveys and Questionnaires