title: Prenatal group visit program for a population with limited English proficiency.
abstract: BACKGROUND
  The declining number of family physicians providing pregnancy care is of concern because they are an important source of pregnancy care in underserved communities. Innovative approaches might reinforce family physician participation in pregnancy care for the underserved. Since group prenatal visits have been shown to improve patient education, support, and satisfaction, we implemented and evaluated a group prenatal visit program for Japanese women in Michigan, an underserved population because of their limited proficiency with English.
  
  
  METHODS
  We conducted a convergent quantitative and qualitative mixed methods evaluation involving repeated survey administration (program evaluations, 4-item Patient Health Questionnaire, pregnancy distress questionnaire) to participants during 5 group visits and in-depth postpartum interviews in the University of Michigan Japanese Family Health Program setting. We conducted independent quantitative and qualitative analytics and then thematically integrated these data.
  
  
  RESULTS
  Cultural adaptations to the Centering Pregnancy format involved changes in total visits, educational content, and participation format. Based on 5 groups attending 5 sessions each, 42 women evaluated the program through 158 surveys after the sessions. Participants evaluated multiple parameters positively: being with other pregnant women (98%), improving their understanding about prenatal care (96%), preparation for labor and delivery (96%), organization of visits (94%), and preparation for newborn care (85%). In final evaluations, 96% to 100% of participants rated 7 educational topics as "covered" or "covered well." Qualitative interviews with 20 women revealed positive views of social support from prenatal group visits and group facilitation but mixed enthusiasm for clinical assessments in the prenatal group visit setting and partner and children attendance at the sessions.
  
  
  CONCLUSIONS
  This research demonstrates the feasibility and cultural acceptability of prenatal group visits for Japanese women. Prenatal group visits provided education and social support for Japanese women during the perinatal and postpartum periods that were not otherwise accessible in Japanese. This study confirms the feasibility of family physicians providing prenatal group visits and extends the literature of the applicability of prenatal group visits for patients with limited English skills.
authors.affiliation: the Department of Family Medicine, University of Michigan, Ann Arbor; and the Takachaya Clinic, Mie Family Practice Center, Tsu City, Mie, Japan.
authors.forename: Sahoko H
authors.initials: SH
authors.lastname: Little
authors.forename: Satoko
authors.initials: S
authors.lastname: Motohara
authors.forename: Kei
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Nora
authors.initials: N
authors.lastname: Arato
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fetters
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D044466:Asian People; D018864:Cultural Diversity; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008824:Michigan; D009819:Office Visits / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: English as a Second Language (ESL); Evaluation Research; Japanese; Mixed Methods Research; Prenatal Care; Underserved Populations