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Pregnancy Passport Program Evaluation
Results
This page provides a limited overview of evaluation results.
Please contact Regional Perinatal System for more detailed information.
The Passport is currently being revised based on the evaluataion
results and will be reprinted in June 2004.
Pregnancy Passport Participants
Pilot sites tracked and reported the number of Passports
given to patients each month. They also recorded the he primary
language spoken and time in pregnancy when Passports were given
(EGA). Five pilot sites participated.
June 2003 - February 2004:
Pregnancy Passports given= 550
Spanish speaking participants= 302
English speaking participants= 248
Average gestational age when given= 20.1 weeks
Qualitative Evaluation (Focus groups/Interviews)
We conducted seven focus groups and three individual interviews
to gain qualitative, in-depth information about women’s opinions
of the Pregnancy Passport, how they use it, and their recommendations
for improvements.
Focus group questions addressed four main areas: (I) Design of the
Pregnancy Passport and program materials; (II)) Use of the Pregnancy
Passport; (III) Health behavior and changes in knowledge; and (IV)
Quantitative information about this and previous pregnancies. Most
questions were open-ended to encourage discussion and allow participants
to determine the direction of the response. The aim was to allow
individuals to respond based on their specific situations and opinions.
Some specific quantitative questions, such as those on pregnancy
history, were also included.
- 43 mothers participated
- 30 participated in Spanish
- 13 participated in English
- 23 were first time mothers
Overall, participants were very positive about the Pregnancy Passport
and felt that it was both valuable and easy to use. Participants
also provided some specific recommendations for changes to the design
and content of the Passport.
Four main themes and several sub-themes emerged
from the combined analysis of participant feedback. These are outlined
below together with selected quotes (in italics) to illustrate the
themes.
- The Pregnancy Passport contains valuable information
related to pregnancy and prenatal care.
- Women like having access to and a better understanding of their
medical information and prenatal test results.
"The definitions are very helpful because now I have
some information on what type of lab tests are being done, whereas
before only the doctor knew and a lot of times I was not aware
of this information."
"I think it's helpful. When I am looking over here I know
what a lot of these abbreviations are but I am looking at some
of them and I think, 'Ok great I think I don't have that because
she didn't mark it but it's kind of nice to look back here and
say oh she didn't mark it because I didn't have group B strep.'
"
- The Pregnancy Passport is an “emergency kit.” It
gives women a sense of comfort because they have their medical
information with them in case of an emergency.
"I feel more comfortable because in my previous pregnancies
I never had anything to carry with me…now I feel more
comfortable and secure with the Passport."
"I think it helps in a good way, you feel more confident,
like if something were to happen you have a little emergency
kit with you, you don’t' have to sit there and explain
to somebody."
- Information on preterm labor and warning signs in the Pregnancy
Passport was important and helped women inform themselves about
these signs.
"I never had problems in my previous pregnancies,
therefore I didn't’t think I would need to know this information,
but after reading the Passport I realized that this information
is important to me and my baby."
"I was given this information [on preterm labor] during
my sixth month in pregnancy, but I didn't think it was that
important. After reading the information on preterm labor in
the Passport I was paying more attention to my body even though
I had no problems."
- The information in the Pregnancy Passport made women more aware
of how to act on signs of preterm labor/ warning signs
"I had to go to the emergency room because I woke
up bleeding a lot, I was like 2 or 3 months, and I looked in
here and read bleeding is not good, there was a lot more information
about cramping and other things, and all the information about
the hospitals and the on call midwives, this is the first thing
I went to for all my information."
"This is very good information because it tells you what
to do and not to alarm yourself."
- The Pregnancy Passport helped increase women’s
involvement and communication with providers.
- The Pregnancy Passport encouraged women to ask more questions.
"When you are pregnant a lot of things happen to you
and it is good to write down things you are feeling because
by the time you go to your appointment you forget what you were
feeling a week ago… the information on this page [page
14] has helped me write down notes on how I feel and questions
that come up so I can ask my doctor… I had never done
this before I received the Passport."
" Before, I would come to my appointments and
felt fine, but as soon as I would leave the clinic I would remember
things I had questions on."
- Specifically, the Pregnancy Passport encouraged women to ask
for more information about prenatal tests.
"I was able to ask questions when they wrote down
information on a lab test. Before my doctor would write this
information down and I never had anything to take home with
me or knew that certain tests were being conducted. Now I can
ask what is being done to me… it has educated me to ask
questions."
"I think it's helpful, because I know that when I started
going to my prenatal appointments and it's my first kid, it
was more like okay, just show up at the doctor's and they do
their test. With this you feel free to question your doctor
about treatments that they are going to do and don't feel that
this needs to be done to you, you don't think about it all the
time and it's nice to have someone telling you it's ok to ask."
- Some women reported improved communication with their healthcare
providers.
"I feel that my communication with my nurse was better
than my previous experiences because as my nurse explains something
she refers to the Passport and also explains the information
as she records it."
- The Prenatal Visits section of the Pregnancy Passport helped
women to stay involved in their pregnancy and prenatal care.
"I think it encourages you to keep up with your
prenatal care too because you started a program and you want
to continue, I think it motivates you more."
"It helps you keep track of each appointment, knowing
your blood pressure and weight at each appointment. You can
see what changes you made at each appointment."
- It is important that healthcare providers explain the Passport
and follow-up later.
"I think that when it was given to me it was like
here this is something to keep you information in and it didn't
click in my head that it was going to be as important like it
seems to be as we've been talking about it. That's why I kind
of never thought to keep it with me at all times. But now that
we've gone through it there is a lot, maybe if it was explained
a little better when it was given to me."
- The Pregnancy Passport is convenient, organized and
easy for women to use.
- The Pregnancy Passport is a “cliff notes” of pregnancy
information- it is convenient, practical, and well-organized.
"I think it's nice to have . . . on hand. You get
books, you read through your pregnancy books but it's nice to
have the little 'cliff notes' right in hand with all your pregnancy
information."
"The Passport is very practical because it is small, it
contains important information and it fits in my purse allowing
me to take it with me to all places."
- The Pregnancy Passport makes it easier to keep important information
about your pregnancy organized and in one place.
"I like the fact that the Passport allows me to carry
all my information regarding my pregnancy in one little booklet
rather than a lot of sheets of paper. It makes it a lot easier
on me because I have a two year old daughter and I can put the
Passport in my purse or in my little girl’s diaper bag."
"If I get other notes from my midwife at the time then
I can stick them with it and I know it won’t get lost
in my purse."
- The Pregnancy Passport gives women a way to share information
about their pregnancy and prenatal care with others.
"I use the Passport to inform my husband on what
is going on in my pregnancy since he can not attend my prenatal
care visits."
"Definitely handy to have this book for the next time
I get pregnant, all I have to do is take this little booklet
and give this to the next doctor because it has all the information
and if I can't remember this is good to have all together."
"In my previous pregnancy I had lab tests done. When
I would go home my husband would ask me about the lab test
and I never knew what to tell him because I was afraid to
ask about the test and have my provider think I was ignorant,
but now I go home and look in the definitions section for
the lab test and get a general idea."
Healthcare Provider Survey Results
(number of participants= 9)
These results provide a good overview of how providers viewed and
used the Passport. Survey results also underscore the fact that
providers agree with the concept of the Pregnancy Passport and see
the value of it, but that there is a need to integrate its use into
routine care to make it more effective.
Provider Survey Results Key: 5=extremely, 1= not at all
- Is the Passport a valuable tool for improving quality of care
at your clinic?
3.75/5 (.75)
- Is the Passport a valuable tool for improving continuity of
care at your clinic?
3.25/ 5 (.65)
- Does the Passport enhance discussion of preterm labor with
patients?
3.36/ 5 (.67)
- Do you support the concept of a handheld record for women to
carry?
5/ 5 (1.00)
- Do you support the concept of the Passport as a way to reinforce
education about preterm labor and how to act on symptoms?
4.63/ 5 (.93)
- Do you feel the Passport enhances communication between women
and their providers?
2.57/ 5 (.51)
- What percentage of your patients receives a Pregnancy Passport?
80%
- Of those, what percentage brings it to at least one subsequent
visit?
77%
- To your knowledge, did any patients who received a Pregnancy
Passport seek care for signs/symptoms of preterm labor or pregnancy
complications?
3= No
1= Yes
5= Unknown
Key Recommendations
- Support by upper level management and administration to fully
implement the program
- Training for clinical and administrative staff at all levels
(Example: training video, in-service)
- Incorporate patient-provider communication skills training (Example:
use existing models and training tools)
- Consumer-driven approach and community outreach to increase
awareness
- Additional rigorous evaluation to track pregnancy outcomes and
changes in knowledge and behavior with use of the Pregnancy Passport
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