Date of Award

Spring 4-21-2023

Embargo Period

4-21-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

First Advisor

Michelle Nichols

Second Advisor

Cristina Lopez

Third Advisor

Julia Phillippi

Abstract

Problem

One million pregnant persons in the United States do not receive early prenatal care or the recommended number of prenatal visits each year, and this gap in care access disproportionately affects people of color, those with lower incomes, and those living in rural communities. Telemedicine was widely utilized in prenatal care during the COVID-19 pandemic, and optimizing prenatal telemedicine has the potential to improve prenatal care access beyond the pandemic.

Purpose

This dissertation focused on examining the integration of virtual visits in routine prenatal care during the COVID-19 pandemic. The purpose of this dissertation was to:

Aim 1. Explore the needs, experiences, and preferences of perinatal providers and patients participating in routine prenatal care during the COVID-19 pandemic.

Aim 2. Identify facilitators and barriers to implementing virtual visits into routine prenatal care through the lens of the normalization process theory’s four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring.

Aim 3. Examine patient demographic characteristics and motivators for utilizing or declining a virtual care model.

Design

This dissertation includes an integrative review that used the social ecological model to analyze factors impacting virtual prenatal visits in original research. In addition, a convergent mixed methods study was conducted with a national sample of pregnant/postpartum patients and perinatal providers from July to December, 2021. Researchers explored participant experiences with telemedicine use in routine prenatal care using the Telehealth Usability Questionnaire, and also analyzed barriers and facilitators that affect the implementation and normalization of prenatal telemedicine using the Normalization Process Theory as a guiding framework.

Findings

The integrative review identified 12 studies and 1 quality improvement project on virtual visits in routine prenatal care. Reviewers found that patient and provider satisfaction were moderate to high using prenatal telemedicine and that there were two comprehensive virtual prenatal care models established prior to the pandemic. They also outlined factors impacting prenatal telemedicine across the five levels of the social ecological model.

The mixed methods dissertation study included 946 survey responses (750 patients, 196 providers) and 30 interviews (15 patients, 15 providers) across 48 states. The primary reasons given for not using telemedicine were that it was not offered, concerns for care quality, and concerns for establishing a patient-provider relationship. Telemedicine utilization was not impacted by parity or income, however urban residents, Black pregnant patients, those planning community births, and those with a graduate degree all had statistically higher usage rates. Researchers identified mild to moderate general satisfaction for patients and providers across the following telehealth usability domains: usefulness, ease of use and learnability, interface quality, interaction quality, reliability, and satisfaction and future use. Barriers and facilitators for normalization of virtual prenatal care were identified across the following Normalization Process Theory constructs: coherence, cognitive participation, collective action, and reflexive monitoring.

Conclusion

An informed understanding of patient and provider experiences along with barriers and facilitators to telemedicine normalization for virtual visits with routine prenatal care can inform and optimize telemedicine delivery. Future research is warranted on how the use and acceptance of prenatal telemedicine will evolve beyond the COVID-19 pandemic.

Rights

Copyright is held by the author. All rights reserved.

Download

Available for download on Monday, April 21, 2025

Share

COinS