Women’s Experiences with Prenatal Care: A Mixed-Methods Study Exploring the Influence of the Social Determinants of Health

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities. Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as non-white. Results: Even when care was perceived as strong quality, participants perceived a lack of patient-centeredness. Participants knew the importance of prenatal care and actively prioritized it even when experiencing challenges accessing healthcare services or barriers to broader conditions needed to be healthy. Participants also reported experiencing discrimination in healthcare. Conclusions & Implications: The women esteemed providers’ clinical advice, but felt unheard in their prenatal care experiences and faced structural challenges which may be addressed by changing institutional policies and procedures

Development, Implementation, and Assessment of Health Equity Action Training (HEAT): Implications for Local Health Departments

As inequities in health persistently plague our nation, rates of chronic disease continue to escalate, and increasing health care costs further debilitate our economy, the profession of public health is faced with monumental challenges. As a central community health institution, the local public health department plays an essential role in eliminating health inequities and preventing chronic disease. With the objective of preparing the local public health workforce to address the root factors associated with health, the Health Equity Action Training project trained 85 staff of the Hartford Department of Health & Human Services in the social determinants of health, social inequities, undoing racism, and cultural competency. Satisfaction results and pre/post assessments with a subsample of participants suggest that this training was effective at improving participants’ health equity attitudes, knowledge, and skills. Implications for local health departments are discussed

Health in Hartford: A Community-Based Participatory Research Project Identifying Solutions to Health Inequities

Overall poor health status and unfair, disparate health outcomes for vulnerable population groups are of grave concern in the United States. Rooted in unequal access to and the disparate quality of the social determinants of health, health inequities disproportionately affect people of lower socioeconomic status and people of color. Defined as the willingness of people to intervene for the good of the community and associated with positive health outcomes, collective efficacy has the potential to reduce health inequities for urban Americans. Hartford, Connecticut is one urban city which unduly suffers from health inequities. Photovoice was the primary methodology used in this qualitative, multistage, longitudinal community-based participatory research (CBPR) study. Photovoice integrates photography, storytelling, and political advocacy. This study aimed to: 1) understand how community members perceive the relationship between place and health in their city; 2) identify participants’ recommendations for improving health in Hartford, Connecticut; and 3) assess how the critical consciousness-building process inherent in photovoice affected participants’ collective efficacy. A total of 24 Hartford residents participated in at least one stage of this study; 11 completed all four stages. Findings revealed that participants conceptualized health into three domains—physical wellness, mental and emotional health, and spirituality. Eight themes were identified involving participants’ perceptions of the critical factors that affect the health of city residents; these are access to healthy food, access to nature, housing and homelessness, substance abuse, litter, education and role models for young people, community investment, and community engagement. Recommendations to improve health were identified for each theme. Participants’ suggestions may be used to develop innovative and practical community interventions; once implemented, these may be evaluated to assess their impact on health. Findings demonstrated that participants’ critical consciousness increased during the photovoice process; however, no changes in their collective efficacy were detected during this study. Methodological constraints posed significant limitations and more robust research is needed to better assess the impact of photovoice on collective efficacy. Implications for professional social work include interprofessional training, specialized education for social workers in community practice, and CBPR methodologies that integrate a human rights framework