title: Facilitators of prenatal care access in rural Appalachia.
abstract: BACKGROUND
  There are many providers and models of prenatal care, some more effective than others. However, quantitative research alone cannot determine the reasons beneficial models of care improve health outcomes. Perspectives of women receiving care from effective clinics can provide valuable insight.
  
  
  METHODS
  We surveyed 29 women receiving care at a rural, Appalachian birth center in the United States with low rates of preterm birth. Semi-structured interviews and demographic questionnaires were analyzed using conventional qualitative content analysis of manifest content.
  
  
  RESULTS
  Insurance was the most common facilitator of prenatal access. Beneficial characteristics of the provider and clinic included: personalized care, unrushed visits, varied appointment times, short waits, and choice in the type and location of care.
  
  
  CONCLUSIONS
  There is a connection between compassionate and personalized care and positive birth outcomes. Women were willing to overcome barriers to access care that met their needs. To facilitate access to prenatal care and decrease health disparities, healthcare planners, and policy makers need to ensure all women can afford to access prenatal care and allow women a choice in their care provider. Clinic administrators should create a welcoming clinic environment with minimal wait time. Unrushed, woman-centered prenatal visits can increase access to and motivation for care and are easily integrated into prenatal care with minimal cost.
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, United States. Electronic address: julia.c.phillippi@vanderbilt.edu.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Phillippi
authors.affiliation: College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Boulevard, Knoxville, TN 37996, United States.
authors.forename: Carole R
authors.initials: CR
authors.lastname: Myers
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, United States.
authors.forename: Mavis N
authors.initials: MN
authors.lastname: Schorn
mesh_terms: D000328:Adult; D001061:Appalachian Region; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007348:Insurance, Health; D007407:Interviews as Topic; D008880:Midwifery; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D018802:Patient-Centered Care; D011247:Pregnancy; D047928:Premature Birth; D011295:Prenatal Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013714:Tennessee
keywords: Appalachia; Health services accessibility; Midwifery; Patient-centered care; Prenatal care