title: Paging "Dr. Google": does technology fill the gap created by the prenatal care visit structure? Qualitative focus group study with pregnant women.
abstract: BACKGROUND
  The prenatal care visit structure has changed little over the past century despite the rapid evolution of technology including Internet and mobile phones. Little is known about how pregnant women engage with technologies and the interface between these tools and medical care, especially for women of lower socioeconomic status.
  
  
  OBJECTIVE
  We sought to understand how women use technology during pregnancy through a qualitative study with women enrolled in the Women, Infants, and Children (WIC) program.
  
  
  METHODS
  We recruited pregnant women ages 18 and older who owned a smartphone, at a WIC clinic in central Pennsylvania. The focus group guide included questions about women's current pregnancy, their sources of information, and whether they used technology for pregnancy-related information. Sessions were audiotaped and transcribed. Three members of the research team independently analyzed each transcript, using a thematic analysis approach. Themes related to the topics discussed were identified, for which there was full agreement.
  
  
  RESULTS
  Four focus groups were conducted with a total of 17 women. Three major themes emerged as follows. First, the prenatal visit structure is not patient-centered, with the first visit perceived as occurring too late and with too few visits early in pregnancy when women have the most questions for their prenatal care providers. Unfortunately, the educational materials women received during prenatal care were viewed as unhelpful. Second, women turn to technology (eg, Google, smartphone applications) to fill their knowledge gaps. Turning to technology was viewed to be a generational approach. Finally, women reported that technology, although frequently used, has limitations.
  
  
  CONCLUSIONS
  The results of this qualitative research suggest that the current prenatal care visit structure is not patient-centered in that it does not allow women to seek advice when they want it most. A generational shift seems to have occurred, resulting in pregnant women in our study turning to the Internet and smartphones to fill this gap, which requires significant skills to navigate for useful information. Future steps may include developing interventions to help health care providers assist patients early in pregnancy to seek the information they want and to become better consumers of Internet-based pregnancy resources.
authors.affiliation: Penn State University College of Medicine, Hershey, PA, United States. jkraschnewski@hmc.psu.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kraschnewski
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
authors.forename: Erika S
authors.initials: ES
authors.lastname: Poole
authors.forename: Tamara
authors.initials: T
authors.lastname: Peyton
authors.forename: Ian
authors.initials: I
authors.lastname: Blubaugh
authors.forename: Jaimey
authors.initials: J
authors.lastname: Pauli
authors.forename: Alyssa
authors.initials: A
authors.lastname: Feher
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006801:Humans; D018802:Patient-Centered Care; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration; D036301:Qualitative Research; D057386:Search Engine; D055815:Young Adult
keywords: Internet; Women, Infants, and Children Program; consumer health informatics; mhealth; mobile phones; patient education; pregnancy resources; prenatal care; qualitative research; smartphones