Exploring the relationship between purpose in life and African American adolescents' use of prenatal care services.

This article presents findings of a study that explored the relationship between purpose in life and African American adolescents' use of prenatal care services. The findings revealed no statistically significant relationship, thus suggesting that purpose in life may not be a crucial factor in determining whether African American adolescents use prenatal care services. The need to explore the influence of other variables on service use and the importance of considering such findings for appropriate health care and social work intervention are discussed.

PIP: Although prenatal care can prevent or minimize many of the risks associated with adolescent pregnancy, most young people either underutilize or avoid this service. This study investigated the hypothesis that adolescents who have a sound sense of life's meaning and purpose will have higher levels of participation in prenatal care than those without such direction. Respondents included 30 African-American adolescent females (mean age, 17 years) referred by a local health center. The mean score on Crumbaugh's Purpose-in-Life test was 97.3 out of a maximum of 140 (high purpose). Other studies utilizing this measure have yielded mean scores ranging from 108.5 for college undergraduates to 118.9 among successful businessmen and professionals. Correlation analysis failed to reveal any significant association between use of prenatal services and purpose in life scores. Overall, these findings suggest that health and social service providers should not place a major emphasis on such philosophical issues when attempting to encourage use of prenatal services among Black youth. It should be considered, however, that this particular measure may lack validity in a sample of very young African-Americans. Recommended are further studies to assess the impact of factors such as agency staffing patterns, modes of service information dissemination, physical environment of service facilities, and instructional content on prenatal care utilization.

Factors affecting number of prenatal care visits during second pregnancy among adolescents having rapid repeat births.

PURPOSE: To examine factors associated with the number of prenatal care visits during second pregnancy for adolescents having a short interval between pregnancies. METHODS: The sample includes all adolescents aged 13 to 17 years whose first pregnancy resulted in a birth at a regional medical center in southeastern North Carolina from January 1983 to December 1989 and who had a repeat pregnancy within 24 months which resulted in a birth. We abstracted data from medical records and birth certificates. We fit a negative binomial regression model to determine the effects of various factors on the number of prenatal care visits during second pregnancy. RESULTS: The number of prenatal care visits during the first pregnancy, poor first birth outcome, interval between first and second pregnancy, and care provided by health department staff during first pregnancy were all positively associated with number of prenatal care visits during second pregnancy when controlling for gestation age of second birth. Other independent variables in the model included maternal age, education, black race, and being unmarried at the time of second birth. CONCLUSIONS: Because prenatal care is important for healthy mothers and babies, adolescents should be encouraged to seek prenatal care early in the first pregnancy. This could be an important time to implement interventions aimed at increasing prenatal care utilization in this and subsequent pregnancies.

PIP: Researchers analyzed data on 287 adolescents who delivered their first child between January 1983 and December 1989 at a regional medical center in southeastern North Carolina and had a repeat pregnancy within 24 months of the first birth to identify factors linked to the number of prenatal care visits during the second pregnancy for these adolescents. They were 13-17 years old during the first pregnancy and 15-19 years old during the second pregnancy. The interval between pregnancies was no more than 12 months for about 50% of the teens and no more than 18 months for more than 80%. The mean interval between pregnancies was 11.1 months. The teens were more likely to have received no prenatal care during their second pregnancy than their first pregnancy (7.9% vs. 2.9%; p 0.001). They also had fewer prenatal visits (7.5 vs. 9.2; p 0.0001). After controlling for gestation age of second birth, factors positively associated with the number of prenatal care visits during the second pregnancy were poor first birth outcome, number of prenatal care visits during first pregnancy, pregnancy interval, and care provided by the county health department. A poor first birth outcome had the greatest impact on the number of prenatal care visits during second pregnancy. These findings indicate the need to encourage teens to seek prenatal care early in their first pregnancy so clinicians can implement interventions which increase prenatal care use during this and subsequent pregnancies.

Help-seeking behavior, use, and satisfaction among frequent primary care users in Santiago de Chile.

PIP: A survey of 140 low-income, urban consumers of primary health care services provided by the public sector at Santiago, Chile's Villa O'Higgins Clinic suggested that organizational factors are more significant predictors of frequency of clinic use and patient satisfaction than demographic characteristics of the clinic population. 73% of respondents interviewed were female; the mean family size was 5, most were from families that fell well below the official poverty level, and 76% of household income went toward food. 29% of the households represented lacked adult men or had unemployed male workers. 66% were acute care patients; the remainder were receiving treatment for chronic conditions such as diabetes, high blood pressure, and alcoholism. 70% had been attending the clinic for the past few years; the mean number of visits per year was 6.4. 53% indicated a preference for a public rather than a private doctor, even if the latter were affordable. Only 51% expressed a dislike of any aspect of the clinic (long waits, 24%; discourteous staff, 19%; and lack of cleanliness, 5%). 84% perceived the quality of the care they received as good; this perception was strongly associated with satisfaction with the physician and receipt of prescription drugs. Multiple regression analysis indicated that 4 organizational variables (travel time to clinic, distance from home to clinic, waiting time at clinic, and travel time-travel distance) and 3 demographic factors (mother bringing child for care, presence of children under 5 years of age, and acute rather than chronic illness) were the best predictors of the frequency of clinic visits. Changes in clinic management by Chile's military government may jeopardize this pattern of high satisfaction with public health services by the poor.^ieng

[Determinants of the utilization of physician services in remote rural areas].

PIP: Data from the 1981 Baseline Household Interview Survey conducted by the Korea Institute for Population and Health were analyzed to assess differential levels of utilization of physicians' services in remote rural areas of Korea. Factors associated with a high frequency of physician visits included: small family size, high educational level, high socioeconomic status, medical security benefits, low travel time to the physician's office, a regular source of medical care, a high incidence of induced abortion, and poor health (self-rated). Multivariate analysis indicated that self-rated health is the single, most important determinant of the number of visits to a physician. Education has two large different direct and indirect effects on utilization: the more highly educated make more visits while higher education leads indirectly to lower physician utilization through improved health status. The data further point to the importance of the presence of a particular physician who is regarded as a person's ongoing source of medical care. The square of the multiple correlation coefficients when the number of visits to a physician was the dependent variable was 0.16. It is stressed that more equitable access to physician services in rural areas of Korea must involve an educational effort to remove cultural barriers as well as expended allocation of health resources.^ieng

Satisfaction with health care. A predictor of adolescents' appointment keeping.

Adolescents are assuming greater responsibility for their own health care, yet have a high rate of broken appointments. The importance of satisfaction with their health care in determining appointment compliance has been demonstrated for adult patients. The purpose of the present study was to explore patient satisfaction among teenagers and its relationship to appointment keeping. A short, reliable instrument was developed to assess adolescent patients' satisfaction with their clinic care. The patient's satisfaction was highly correlated with subsequent compliance in coming for appointments. Satisfaction, hence, appointment keeping, was higher in females, older adolescents, those making their own initial clinic appointment, those with a positive body image, and those scoring high on a test of personal freedom.

PIP: Adolescents are assuming greater responsability for their own health care, yet have a high rate of broken appointments. The importance of satisfaction with their health care in determining appointment compliance has been demonstrated for adult patients. The purpose of the present study was to explore patient satisfaction among teenagers and its realtionship to appointment keeping. A short, reliable instrument was developed to assess adolescent patients' satisfaction with their clinic care. The patient's satisfaction was highly correlated with subsequent compliance in coming for appointments. Satisfaction, hence, appointment keeping, was higher in females, older adolescents, those making their own initial clinic appointment, those with a positive body image, and those scoring high on a test of personal freedom. The questionnaire that was administered comprised 21 items. There were 26 males and 37 females in the final sample. 50% were white, middle class, and suburban; 35% were black; and 15% were Chicano from the low S.E.S. communities of San Jose, California.