Perceptions of barriers, facilitators and motivators related to use of prenatal care: A qualitative descriptive study of inner-city women in Winnipeg, Canada.
OBJECTIVE
The objective of this qualitative descriptive study was to explore the perceptions of women living in inner-city Winnipeg, Canada, about barriers, facilitators, and motivators related to their use of prenatal care.


METHODS
Individual, semi-structured interviews were conducted in person with 26 pregnant or postpartum women living in inner-city neighborhoods with high rates of inadequate prenatal care. Interviews averaged 67 min in length. Recruitment of participants continued until data saturation was achieved. Inductive content analysis was used to identify themes and subthemes under four broad topics of interest (barriers, facilitators, motivators, and suggestions). Sword's socio-ecological model of health services use provided the theoretical framework for the research. This model conceptualizes service use as a product of two interacting systems: the personal and situational attributes of potential users and the characteristics of health services.


RESULTS
Half of the women in our sample were single and half self-identified as Aboriginal. Participants discussed several personal and system-related barriers affecting use of prenatal care, such as problems with transportation and child care, lack of prenatal care providers, and inaccessible services. Facilitating factors included transportation assistance, convenient location of services, positive care provider qualities, and tangible rewards. Women were motivated to attend prenatal care to gain knowledge and skills and to have a healthy baby.


CONCLUSIONS
Consistent with the theoretical framework, women's utilization of prenatal care was a product of two interacting systems, with several barriers related to personal and situational factors affecting women's lives, while other barriers were related to problems with service delivery and the broader healthcare system. Overcoming barriers to prenatal care and capitalizing on factors that motivate women to seek prenatal care despite difficult living circumstances may help improve use of prenatal care by inner-city women.
College of Nursing, University of Manitoba, Winnipeg, MB, Canada.
Maureen I
MI
Heaman
School of Nursing, University of Ottawa, Ottawa, ON, Canada.
Wendy
W
Sword
Departments of Community Health Sciences and Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.
Lawrence
L
Elliott
Departments of Community Health Sciences and Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Michael
M
Moffatt
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada.
Michael E
ME
Helewa
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
Heather
H
Morris
Public Health, Winnipeg Regional Health Authority, Winnipeg, MB, Canada.
Lynda
L
Tjaden
Department of Nursing, Red River College, Winnipeg, MB, Canada.
Patricia
P
Gregory
Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB, Canada.
Catherine
C
Cook
Prenatal care; access to care; barriers; facilitators; inner-city; motivators; pregnancy; qualitative study