Child Care as a Barrier to Perinatal Health Care in Illinois.

PURPOSE: Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017-2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care DESCRIPTION: TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60). ASSESSMENT: Each group reported that child care concerns negatively affect health care utilization (66% of birthing hospitals, 50% of FQHCs, and 32% of postpartum persons). Among postpartum persons, the most common reported reason for missing a visit due to child care issues was "not feeling comfortable leaving my child(ren) in the care of others" (22%). The most common child care resource reported by facilities was "staff watching children" (53% of birthing hospitals, 75% of FQHCs); however, most did not have formal child care policies or dedicated space for children. Fewer than half of FQHCs (43%) discussed child care at the first prenatal visit. CONCLUSION: The project prompted the Illinois Title V program to add a child care-related strategy to their 2021-2025 Action Plan, providing opportunity for further examination of practices and policies that could be implemented to reduce child care barriers to perinatal care. Systematically addressing child care in health care settings may improve health care utilization among birthing/postpartum persons.

Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review.

OBJECTIVE: This systematic review focused on randomized controlled trials (RCTs) with physicians and nurses that tested interventions designed to improve their mental health, well-being, physical health, and lifestyle behaviors. DATA SOURCE: A systematic search of electronic databases from 2008 to May 2018 included PubMed, CINAHL, PsycINFO, SPORTDiscus, and the Cochrane Library. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria included an RCT design, samples of physicians and/or nurses, and publication year 2008 or later with outcomes targeting mental health, well-being/resiliency, healthy lifestyle behaviors, and/or physical health. Exclusion criteria included studies with a focus on burnout without measures of mood, resiliency, mindfulness, or stress; primary focus on an area other than health promotion; and non-English papers. DATA EXTRACTION: Quantitative and qualitative data were extracted from each study by 2 independent researchers using a standardized template created in Covidence. DATA SYNTHESIS: Although meta-analytic pooling across all studies was desired, a wide array of outcome measures made quantitative pooling unsuitable. Therefore, effect sizes were calculated and a mini meta-analysis was completed. RESULTS: Twenty-nine studies (N = 2708 participants) met the inclusion criteria. Results indicated that mindfulness and cognitive-behavioral therapy-based interventions are effective in reducing stress, anxiety, and depression. Brief interventions that incorporate deep breathing and gratitude may be beneficial. Visual triggers, pedometers, and health coaching with texting increased physical activity. CONCLUSION: Healthcare systems must promote the health and well-being of physicians and nurses with evidence-based interventions to improve population health and enhance the quality and safety of the care that is delivered.

Defining new categories of pregnancy intention in African-American women.

OBJECTIVE: Half of all U.S. pregnancies are categorized as unintended at conception, but concerns persist that existing measures of pregnancy intention do not adequately reflect the complexities of reproductive desires and preferences. We explored new strategies for categorizing viewpoints toward future pregnancy focusing on young, low-income, African-American women, and assessed the stability of these viewpoints over time. For pregnancies that occurred during the study, we examined the utility of the newly derived categories for predicting retrospective measures of intendedness. METHODS: Data were collected using Q-methodology, a technique for eliciting subjective viewpoints and identifying shared patterns among individuals. African-American women ages 15 to 25 and at risk for pregnancy were recruited at clinics serving low-income populations. The women sorted statements reflecting attitudes and preferences regarding future pregnancy into a distribution on a continuum from "least true for me" to "most true for me." We used by-person factor analysis to derive latent viewpoints. RESULTS: We identified six factors each reflecting a unique viewpoint about future pregnancy. These were a pregnancy seeking factor, one reflecting both ambivalence and low reproductive control, and four reflecting pregnancy avoidance, with distinctions around social support, reproductive control, and desired pregnancy timing. Distribution of factors differed by age group, as well as by retrospective categorization of pregnancy intention for those women who became pregnant during the study. CONCLUSION: Our categories provide a nuanced reflection of women's points of view about future pregnancies, and, with further validation, may prove useful for predicting or preventing contraceptive nonuse, undesired conceptions, and associated adverse outcomes.