Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers

Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

Iterative development of a multiple technology-based physical activity intervention for Latina adolescents: The Chicas Fuertes Study (Preprint)

BACKGROUND Adolescent girls report the lowest levels of physical activity (PA) of any demographic group, with rates especially low for racial/ethnic minority girls. Only 3% of Latina teens meet national PA guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary for preventing disease and reducing disparities. OBJECTIVE The study objective was to develop a mHealth PA intervention for Latina adolescents using a multi-stage iterative process based on an adaptation of the IDEAS (Integrate, DEsign, Assess, Share) framework. METHODS Development of the intervention was accomplished through three iterations: 1) feedback from a previous web-based pilot study, Niñas Saludables; 2) conducting focus groups with the target population; and, 3) vetting the final materials with a youth advisory board (YAB) comprising Latina adolescents. Based on feedback from participants in the Niñas Saludables study, plans to improve the intervention included incorporating visual social media posts and text messaging, adding a commercial wearable tracker, and revising the existing website to be primarily visual; proposed procedures and material were then refined through focus groups. Participants for focus groups (N=50) were girls age 13-18 who could speak and read in English who were recruited from local high schools and after school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps, and specific feedback on intervention material prototypes and possible names and logos. Materials were refined based on their feedback, then were beta tested by the YAB. YAB members (N=4) were Latinas age 13-18 who were not regularly active and were recruited via word of mouth and selected through an application process. RESULTS The focus group discussions yielded the following findings: PA preferences included walking, running and group fitness classes, while the least popular activities were running, swimming, and biking. Most participants used some form of social media, with Instagram being the most favored. Participants preferred text messages be sent no more than once a day, be personalized, and be positively worded. Focus group participants preferred an intervention directly targeting Latinas, and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinements including incorporation of some Spanish phrases. CONCLUSIONS Latina teens were generally enthusiastic about an mHealth PA intervention, provided the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback with the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product.

Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.

Youth-Centered Maternity Care: A Binational Qualitative Comparison of the Experiences and Perspectives of Latina Adolescents and Healthcare Providers

Background: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including pregnant and parenting adolescents as well as providers between December 2016 and July 2017. Transcripts in English and Spanish were coded and analyzed using Dedoose software. Results were compared by location and between youth and providers. Results: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.