Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the s... more Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the state's children's health insurance program, Florida KidCare. FL-CKF facilitates the development of local coalitions to reach children and families throughout the state. Coalitions are provided with one-on-one training and a wide array of tools to increase effectiveness such as coalition-building resources, membership guides, and assistance in building strong local partnerships. FL-CKF places emphasis on creating formalized membership structures so each member knows his or her responsibilities and is accountable for them, partnering with other organizations in the community, and training on how to create and maintain partnerships in the community at large. These approaches help create lasting coalitions and offer an easily replicable approach for others to enhance children's health insurance outreach and enrollment.
To examine contributing factors and potential reasons for hospital differences in unexpected newb... more To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences. Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery...
ABSTRACT Background: Pregnancy represents a critical period influencing oral-systemic health acro... more ABSTRACT Background: Pregnancy represents a critical period influencing oral-systemic health across the lifecourse. Subsequently, consolidated guidelines have been co-endorsed by medical and dental professional associations highlighting the importance of oral health prevention and treatment among pregnant women. The purpose of this study was to assess current behaviors, barriers and future opportunities to facilitate the translation of the inter-professional practice guidelines into practice for prenatal providers (PPs) and oral healthcare providers (OHPs). Methods: Twenty-two in-depth interviews were conducted with PPs and OHPs based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Results: Data revealed a significant gap in translating guidelines into practice. Specifically, PPs rarely assessed, educated or referred pregnant patients to oral healthcare; whereas OHPs reported providing extensive education and treatment to patients. However, only one-directional communication occurred between providers, with OHPs requesting PP approval to provide care to pregnant patients. Key barriers to inter-professional care identified included lack of time and training, and a physical and social disconnect between disciplines. Opportunities to improve inter-professional practice behaviors included professional training, continuing education, conferences, accreditation, and communication processes using eHealth that involve both disciplines. Conclusions: Findings suggest a lack of reciprocal communications between and among patients/providers with regards to prenatal oral health. Thus, future research should develop, implement and evaluate theory- and evidence-based dissemination and implementation strategies that facilitate inter-professional practice behaviors with regards to prenatal oral health. Such efforts have the potential to significantly improve maternal and child oral-systemic health across the lifecourse.
Purpose According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children un... more Purpose According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children under 19 years of age are uninsured, giving Florida the second largest number of uninsured children in the United States. Florida Covering Kids & Families (FL-CKF) is dedicated to developing innovative outreach methods for enrolling and retaining eligible children in Florida KidCare, the state's Children's Health Insurance Program. FL-CKF has developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. Description The data system was created using the Checkbox survey systems. Community and school outreach partners enter data each month on all completed Florida KidCare applications via a secure interface. The system requires data be entered in a uniform format and forces vital data points to be completed. These data are then transmitted to the state to obtain timely application determination information on enrollments. Assessment The data system helps FL-CKF to determine which outreach strategies are successful and where changes need to be made to increase effectiveness. The system also provides feedback to community outreach partners in order to enable follow up with families when needed. Conclusion Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.
Background: Pregnancy represents a critical period influencing oral-systemic health across the li... more Background: Pregnancy represents a critical period influencing oral-systemic health across the lifecourse. Subsequently, consolidated guidelines have been co-endorsed by medical and dental professional associations highlighting the importance of oral health prevention and treatment among pregnant women. The purpose of this study was to assess current behaviors, barriers and future opportunities to facilitate the translation of the inter-professional practice guidelines into practice for prenatal providers (PPs) and oral healthcare providers (OHPs). Methods: Twenty-two in-depth interviews were conducted with PPs and OHPs based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Results: Data revealed a significant gap in translating guidelines into practice. Specifically, PPs rarely assessed, educated or referred pregnant patients to oral healthcare; whereas OHPs reported providing extensive education and treatm...
Pregnancy is identified as a sensitive period of increased risk for poor oral health among mother... more Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers' information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient's complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.
Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including pret... more Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low-birthweight infants. Little is known about childbearing women's experiences in obtaining dental care. The objective of this study was to explore Florida women's experience of barriers in obtaining dental care before and during their pregnancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face-to-face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women's experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were assessed about the participants' perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women's access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted.
Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida P... more Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.
MCN. The American journal of maternal child nursing
To explore the perinatal experiences of African American women in Florida for obtaining informati... more To explore the perinatal experiences of African American women in Florida for obtaining information about breastfeeding and also their breastfeeding experiences. This qualitative study utilized convenience sampling of 253 African American women 18 to 35 years old in three Florida counties. Data were derived from the Healthy Futures Perinatal Research and System Design study. One month after giving birth, face-to face interviews were conducted using an interview schedule. Questions about breastfeeding education and experiences were explored. Taped responses were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were identified. Most women received some information about breastfeeding during prenatal care. Mothers who chose to breastfeed were usually aware of some of the benefits for the baby and occasionally benefits for themselves. Mothers who did not breastfeed were concerned about pain associated with breastfeeding, time constraints, return...
Published guidelines (ACOG 1979) advise against non-medically indicated (NMI) deliveries before 3... more Published guidelines (ACOG 1979) advise against non-medically indicated (NMI) deliveries before 39 weeks gestation due to increased risk of neonatal mortality and morbidity. Six Florida hospitals participated in the March of Dimes Big 5 Hospital Network to pilot test a toolkit to eliminate such deliveries. Evaluation of the pilot included two interviews with each hospital team on implementation challenges and successes. Phone interviews were conducted with hospital teams at six months post-implementation and at the end of the yearlong pilot. Interview topics included data collection and use, physician/nurse leadership, barriers to system change, project challenges/successes, and hospital demographics. Questions were provided to hospitals prior to the interviews to enhance response quality. Answers were captured in written notes which were summarized and circulated to the interviewers to assure accuracy and completeness. Interview data from all hospitals was sorted and consolidated b...
Background: Nearly 800,000 uninsured children reside in Florida, and of those, more than 500,000 ... more Background: Nearly 800,000 uninsured children reside in Florida, and of those, more than 500,000 may qualify for Florida KidCare, the state's health insurance plan for children. The Florida Covering Kids & Families Coalition (FL-CKF) dedicates efforts to engage hard-to-reach communities and to disseminate information about the existence of Florida KidCare. Innovative technology that can shorten the length of time to enroll or renew a family, while ensuring accountability to stakeholders, can greatly enhance the capabilities of front-line community partners in increasing enrollment rates. Purpose: To demonstrate the utility of an electronic information system to compile and transmit application information to relevant stakeholders. Methods: The information needs of the different stakeholders from the FL-CKF coalition determined the inputs and outputs necessary to design and implement an Electronic Information System (EIS). A user-friendly interface utilizing online survey softwar...
Missed appointments are a significant problem in a healthcare system. They can cause problems for... more Missed appointments are a significant problem in a healthcare system. They can cause problems for both the practice and the patient. To help a large OB/GYN clinic in South Florida discern typical reasons for missed appointments, a concurrent triangulation design was used in which patient responses on a quantitative mail survey of reasons for missed appointments were compared with those obtained through in-depth interviews. Initial quantitative results indicated appointments were missed due to forgetting, lack of transportation, and lack of childcare. Interview results revealed women had more complicated and emotional reasons behind missed appointments, such as embarrassment, than those identified in the quantitative survey. Interview data revealed that cognitive barriers may be the more likely reason behind missed appointments than structural barriers such as transportation and lack of childcare.
Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the s... more Mothers and Babies advocates for uninsured children and promotes outreach and enrollment in the state's children's health insurance program, Florida KidCare. FL-CKF facilitates the development of local coalitions to reach children and families throughout the state. Coalitions are provided with one-on-one training and a wide array of tools to increase effectiveness such as coalition-building resources, membership guides, and assistance in building strong local partnerships. FL-CKF places emphasis on creating formalized membership structures so each member knows his or her responsibilities and is accountable for them, partnering with other organizations in the community, and training on how to create and maintain partnerships in the community at large. These approaches help create lasting coalitions and offer an easily replicable approach for others to enhance children's health insurance outreach and enrollment.
To examine contributing factors and potential reasons for hospital differences in unexpected newb... more To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences. Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery...
ABSTRACT Background: Pregnancy represents a critical period influencing oral-systemic health acro... more ABSTRACT Background: Pregnancy represents a critical period influencing oral-systemic health across the lifecourse. Subsequently, consolidated guidelines have been co-endorsed by medical and dental professional associations highlighting the importance of oral health prevention and treatment among pregnant women. The purpose of this study was to assess current behaviors, barriers and future opportunities to facilitate the translation of the inter-professional practice guidelines into practice for prenatal providers (PPs) and oral healthcare providers (OHPs). Methods: Twenty-two in-depth interviews were conducted with PPs and OHPs based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Results: Data revealed a significant gap in translating guidelines into practice. Specifically, PPs rarely assessed, educated or referred pregnant patients to oral healthcare; whereas OHPs reported providing extensive education and treatment to patients. However, only one-directional communication occurred between providers, with OHPs requesting PP approval to provide care to pregnant patients. Key barriers to inter-professional care identified included lack of time and training, and a physical and social disconnect between disciplines. Opportunities to improve inter-professional practice behaviors included professional training, continuing education, conferences, accreditation, and communication processes using eHealth that involve both disciplines. Conclusions: Findings suggest a lack of reciprocal communications between and among patients/providers with regards to prenatal oral health. Thus, future research should develop, implement and evaluate theory- and evidence-based dissemination and implementation strategies that facilitate inter-professional practice behaviors with regards to prenatal oral health. Such efforts have the potential to significantly improve maternal and child oral-systemic health across the lifecourse.
Purpose According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children un... more Purpose According to the Kaiser Family Foundation (2014), 502,866 (11.7 %) of Florida children under 19 years of age are uninsured, giving Florida the second largest number of uninsured children in the United States. Florida Covering Kids & Families (FL-CKF) is dedicated to developing innovative outreach methods for enrolling and retaining eligible children in Florida KidCare, the state's Children's Health Insurance Program. FL-CKF has developed a strong data system that allows it to evaluate the effectiveness and success of statewide enrollment and retention efforts. Description The data system was created using the Checkbox survey systems. Community and school outreach partners enter data each month on all completed Florida KidCare applications via a secure interface. The system requires data be entered in a uniform format and forces vital data points to be completed. These data are then transmitted to the state to obtain timely application determination information on enrollments. Assessment The data system helps FL-CKF to determine which outreach strategies are successful and where changes need to be made to increase effectiveness. The system also provides feedback to community outreach partners in order to enable follow up with families when needed. Conclusion Organizations helping uninsured children apply for health insurance may benefit from creating data collection systems to monitor project efficacy and modify outreach and enrollment strategies for greater effectiveness.
Background: Pregnancy represents a critical period influencing oral-systemic health across the li... more Background: Pregnancy represents a critical period influencing oral-systemic health across the lifecourse. Subsequently, consolidated guidelines have been co-endorsed by medical and dental professional associations highlighting the importance of oral health prevention and treatment among pregnant women. The purpose of this study was to assess current behaviors, barriers and future opportunities to facilitate the translation of the inter-professional practice guidelines into practice for prenatal providers (PPs) and oral healthcare providers (OHPs). Methods: Twenty-two in-depth interviews were conducted with PPs and OHPs based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Results: Data revealed a significant gap in translating guidelines into practice. Specifically, PPs rarely assessed, educated or referred pregnant patients to oral healthcare; whereas OHPs reported providing extensive education and treatm...
Pregnancy is identified as a sensitive period of increased risk for poor oral health among mother... more Pregnancy is identified as a sensitive period of increased risk for poor oral health among mothers and offspring. Subsequently, both medical and dental associations have re-endorsed consolidated, inter-professional guidelines promoting oral health during pregnancy. The objective was to explore prenatal and oral health providers' information, motivation and practice behaviors related to oral health during pregnancy. Twenty-two in-depth interviews were conducted with prenatal and oral health providers based on the Information-Motivation-Behavioral Skills Model. Data were analyzed using the constant comparative method in NVivo 10. Providers held variable knowledge with regards to identified oral-systemic connections and implications. Most providers were unaware of the guidelines; however, some oral health providers reported avoiding specific treatment behaviors during this period. Motivation to address oral-systemic health during pregnancy included: prevention; healthy pregnancy/birth outcomes; patient's complaint/question as cue to action; comprehensive, patient-centered, and family-centered care; ethical duty; and professional governing body. Oral health providers reported assessing, educating, and communicating with patients about oral health issues; whereas prenatal providers rarely addressed oral health but reported signing approval forms to receive such care. A few oral health providers highlighted lifecourse implications and the need for family-centered care when addressing poor oral health among pregnant patients. Findings suggest gaps in oral health prevention information and behaviors among prenatal and oral health providers. Future efforts should examine effective dissemination and implementation strategies that translate evidence-based guidelines into clinical practice, with the ultimate goal of improve oral-systemic health among women and their offspring across the lifecourse.
Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including pret... more Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low-birthweight infants. Little is known about childbearing women's experiences in obtaining dental care. The objective of this study was to explore Florida women's experience of barriers in obtaining dental care before and during their pregnancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face-to-face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women's experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were assessed about the participants' perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women's access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted.
Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida P... more Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.
MCN. The American journal of maternal child nursing
To explore the perinatal experiences of African American women in Florida for obtaining informati... more To explore the perinatal experiences of African American women in Florida for obtaining information about breastfeeding and also their breastfeeding experiences. This qualitative study utilized convenience sampling of 253 African American women 18 to 35 years old in three Florida counties. Data were derived from the Healthy Futures Perinatal Research and System Design study. One month after giving birth, face-to face interviews were conducted using an interview schedule. Questions about breastfeeding education and experiences were explored. Taped responses were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were identified. Most women received some information about breastfeeding during prenatal care. Mothers who chose to breastfeed were usually aware of some of the benefits for the baby and occasionally benefits for themselves. Mothers who did not breastfeed were concerned about pain associated with breastfeeding, time constraints, return...
Published guidelines (ACOG 1979) advise against non-medically indicated (NMI) deliveries before 3... more Published guidelines (ACOG 1979) advise against non-medically indicated (NMI) deliveries before 39 weeks gestation due to increased risk of neonatal mortality and morbidity. Six Florida hospitals participated in the March of Dimes Big 5 Hospital Network to pilot test a toolkit to eliminate such deliveries. Evaluation of the pilot included two interviews with each hospital team on implementation challenges and successes. Phone interviews were conducted with hospital teams at six months post-implementation and at the end of the yearlong pilot. Interview topics included data collection and use, physician/nurse leadership, barriers to system change, project challenges/successes, and hospital demographics. Questions were provided to hospitals prior to the interviews to enhance response quality. Answers were captured in written notes which were summarized and circulated to the interviewers to assure accuracy and completeness. Interview data from all hospitals was sorted and consolidated b...
Background: Nearly 800,000 uninsured children reside in Florida, and of those, more than 500,000 ... more Background: Nearly 800,000 uninsured children reside in Florida, and of those, more than 500,000 may qualify for Florida KidCare, the state's health insurance plan for children. The Florida Covering Kids & Families Coalition (FL-CKF) dedicates efforts to engage hard-to-reach communities and to disseminate information about the existence of Florida KidCare. Innovative technology that can shorten the length of time to enroll or renew a family, while ensuring accountability to stakeholders, can greatly enhance the capabilities of front-line community partners in increasing enrollment rates. Purpose: To demonstrate the utility of an electronic information system to compile and transmit application information to relevant stakeholders. Methods: The information needs of the different stakeholders from the FL-CKF coalition determined the inputs and outputs necessary to design and implement an Electronic Information System (EIS). A user-friendly interface utilizing online survey softwar...
Missed appointments are a significant problem in a healthcare system. They can cause problems for... more Missed appointments are a significant problem in a healthcare system. They can cause problems for both the practice and the patient. To help a large OB/GYN clinic in South Florida discern typical reasons for missed appointments, a concurrent triangulation design was used in which patient responses on a quantitative mail survey of reasons for missed appointments were compared with those obtained through in-depth interviews. Initial quantitative results indicated appointments were missed due to forgetting, lack of transportation, and lack of childcare. Interview results revealed women had more complicated and emotional reasons behind missed appointments, such as embarrassment, than those identified in the quantitative survey. Interview data revealed that cognitive barriers may be the more likely reason behind missed appointments than structural barriers such as transportation and lack of childcare.
Uploads
Papers by Linda Detman