Clinical Research
Barriers to Prenatal Care for Homeless Pregnant Women

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Objective:

The purpose of this study was to explore and describe the barriers to prenatal care for homeless pregnant women.

Design:

A descriptive survey with written questionnaires.

Participants:

About 183 pregnant homeless women live in Northeast Florida in any given month. More than 250 surveys were distributed to homeless pregnant women via agencies that provide shelter and/or services to homeless people in Northeast Florida. Forty-seven surveys were returned, representing 25.7% of the estimated population.

Main Outcome Measure:

Barriers to prenatal care were measured using Melnyk’s Barriers Scale, a 27‐item Likert‐type scale.

Results:

Of the respondents, 75.61% perceived barriers to prenatal care. Site‐related factors were the most significant, followed by provider/client relationship, inconvenience, fear, and cost.

Conclusions:

Although prenatal care is available to all pregnant women in Northeast Florida, barriers to accessing this care for homeless pregnant women are significant and need to be addressed by health care providers and administrators. Additional qualitative study of these issues is warranted.

Section snippets

Literature Review

Homelessness has a profound effect on an individual’s ability to maintain health. Homeless individuals often are victims of environmental exposure, infestations, peripheral vascular disease, respiratory infections and tuberculosis, and mental illness (Hwang, 2001; Kushel, Vittinghoff, & Haas, 2001).

Because of unsafe environments and high-risk lifestyles, women who are homeless are at increased risk for sexually transmitted diseases, including HIV and hepatitis (Nyamathi, Flaskerud, Leake,

Methodology

This study used a descriptive survey design to identify perceived barriers to care among women who are currently pregnant and homeless, or who have delivered a child while homeless within the previous 6 months. Homelessness was defined as not having a stable place to live and included women living in established shelters, in improvised shelters, in the home of a stranger, on the streets or out of a car, and women who have lived in three or more places within the past year. Prenatal care was

Sample and Procedure

Following approval by the institutional review board, a convenience sample of homeless pregnant women was recruited through agencies serving homeless women. Completion of the questionnaire constituted consent to participate in the research. An initial telephone survey of all agencies in Northeast Florida providing shelter and/or services to the homeless revealed an estimated 183 homeless pregnant women in any given month. These agencies included homeless shelters, domestic violence shelters,

Instruments

Participants completed a demographic data form that included age, race, marital status, educational level, current working status, stability and safety of their current living arrangements, current and previous pregnancies, substance use and abuse, and information about prenatal care and plans for place of birth.

Perceived barriers to prenatal care were measured using Melnyk’s Barriers Scale (Melnyk, 2008)

Sample Demographics

The 47 participants ranged in age from 12 to 38 years (M = 24.96; SD = 6.14). Seven (14.9%) were younger than age 20. The majority (55.3%) were African American and single (66%; see Table 1). Thirty-nine (83.9%) had been pregnant at least once before (range = 1 to 10, M = 2.81, SD = 2.33), and 18 (38.3%) had children currently with them (range = 1 to 6). Twenty-seven (57.4%) had less than a high school education. Nine participants (19.1%) were working either full or part time, 11 (23.4%) were

Acknowledgments

Funding was provided by a research grant from the Northeast Florida Healthy Start Coalition. Dr. Ruth Robillard is acknowledged for her assistance in this research study.

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