title: Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers.
abstract: BACKGROUND
  Socioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization.
  
  
  METHODS
  A descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis.
  
  
  RESULTS
  Many of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population.
  
  
  CONCLUSIONS
  The broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study.
authors.affiliation: College of Nursing Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada. Maureen.Heaman@umanitoba.ca.|Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. Maureen.Heaman@umanitoba.ca.|Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0L8, Canada. Maureen.Heaman@umanitoba.ca.
authors.forename: Maureen I
authors.initials: MI
authors.lastname: Heaman
authors.affiliation: School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8N 3Z5, Canada. sword@mcmaster.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. Lawrence.Elliott@med.umanitoba.ca.|Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0J9, Canada. Lawrence.Elliott@med.umanitoba.ca.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Elliott
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. mmoffatt@exchange.hsc.mb.ca.|Department of Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1S1, Canada. mmoffatt@exchange.hsc.mb.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Moffatt
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0L8, Canada. MHELEWA@sbgh.mb.ca.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Helewa
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, AB, T5G 1C9, Canada. hmmorris@ualberta.ca.
authors.forename: Heather
authors.initials: H
authors.lastname: Morris
authors.affiliation: Department of Nursing, Red River College, Winnipeg, MB, R3H 0J9, Canada. pgregory@rrc.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Gregory
authors.affiliation: Public Health, Winnipeg Regional Health Authority, Winnipeg, MB, R3A 0X7, Canada. ltjaden@wrha.mb.ca.
authors.forename: Lynda
authors.initials: L
authors.lastname: Tjaden
authors.affiliation: Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB, R3B 1E2, Canada. ccook@wrha.mb.ca.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cook
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D065246:Culturally Competent Care; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008880:Midwifery; D009722:Nurse Practitioners; D009773:Obstetric Nursing; D009774:Obstetrics; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011637:Public Health Nursing; D036301:Qualitative Research; D012944:Social Support; D013997:Time Factors; D014186:Transportation; D014505:Urban Population; D000078329:Workforce