Date on Master's Thesis/Doctoral Dissertation

5-2024

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Karimi, Seyed

Committee Co-Chair (if applicable)

Little, Bertis

Committee Member

Little, Bertis

Committee Member

Creel, Liza

Committee Member

Ibrahim, Bridget Basile

Committee Member

Kendig, Sue

Author's Keywords

prenatal; Kentucky; timing; maternal; regression discontinuity

Abstract

Objectives: Early prenatal care is initiated in the first twelve weeks of pregnancy and is a known contributor to improved short- and long-term outcomes for women and infants. Despite its known benefits, many women do not initiate early prenatal care. The purpose of this dissertation was to explore the socioecological factors associated with the timing of prenatal care initiation in the United States and in Kentucky. Methods: Chapter Two of this dissertation used a scoping review methodology to identify barriers and facilitators related to first-trimester prenatal care initiation among women in the United States. Chapter Three of this dissertation used Phase 8 Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) data in a cross-sectional analysis to identify factors associated with early prenatal care initiation among women in Kentucky. A linear and logistic regression were used to examine the relationship between early prenatal care and intrapersonal factors such as maternal race, education, and pregnancy intention. Chapter Four of this dissertation used the Phase 8 Kentucky PRAMS data (2017-2020) in a quasi-experimental regression discontinuity design to assess the impact of COVID-19 on the timing of prenatal care initiation among women in Kentucky. The Socioecological Model (SEM) was used as the guiding framework for all three dissertation papers. Results: Early prenatal care initiation was associated with factors in the intrapersonal, interpersonal, and societal/environmental domains of the SEM. Early initiation was positively associated with intended pregnancy, pre-conception health insurance, prenatal care health insurance, higher levels of maternal education, and higher household income. The COVID-19 pandemic, an environmental domain factor of the SEM, was associated with a nearly 2-week delay in the timing of prenatal care initiation among women who conceived in the months immediately preceding the start of the pandemic. Conclusions: The timing of prenatal care initiation is influenced by a multitude of interdependent factors in the intrapersonal, interpersonal, and environmental domains of the SEM. This dissertation highlights the need for holistic policy and practice solutions that can facilitate earlier entry to prenatal care and improve outcomes for women and infants.

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