title: Facilitators of prenatal care in an exemplar urban clinic.
abstract: BACKGROUND
  Perinatal outcomes have complex causes that include biologic, maternal, structural, and societal components. We studied one urban nurse-led clinic serving women at risk for poor perinatal outcomes with superior pre-term birth rates (4%) when compared with the surrounding county (11.2%).
  
  
  OBJECTIVE
  To explore women's perspectives of their interface with the clinic, staff, and providers to understand this exemplary model.
  
  
  METHODS
  A qualitative descriptive approach with semi-structured interviews as the primary data source. Participants (n=50) were recruited from an urban clinic in the Southeast United States designed to serve women of low socio-economic status or who are recent immigrants.
  
  
  RESULTS
  Women greatly valued a personal connection with the nurse-midwives and staff, and felt this resulted in high-quality care. Convenient appointment times and the lack of wait for initial or subsequent appointments made care accessible. Participants reported the relaxed and helpful approach and attitudes of the office staff were essential components of their positive experience. Women valued unrushed visits to ask questions and receive information. In addition, participants felt that clinic staff were easy to reach.
  
  
  CONCLUSIONS
  While qualitative data cannot demonstrate causation, this study provides support that a compassionate and personalized approach to care motivates women to access needed services in pregnancy. Clinic staff are an essential component of the access process. Women overcame barriers to obtain personalized, culturally appropriate care provided by kind, competent practitioners. Clinic staff and practitioners should develop a connection with each woman by providing care that meets her physical, cultural, and personal needs.
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Ave 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: Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, United States.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Holley
authors.affiliation: Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End, Suite 400, Nashville, TN 37203, United States.
authors.forename: Kate
authors.initials: K
authors.lastname: Payne
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, United States.
authors.forename: Mavis N
authors.initials: MN
authors.lastname: Schorn
authors.affiliation: Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN 37240, United States.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Karp
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery; D009721:Nurse Midwives; D036801:Parturition; D018802:Patient-Centered Care; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D055815:Young Adult
keywords: Access; Health systems accessibility; Midwifery; Patient-centered care; Prenatal care