Impact of telehealth on patient-provider communication in prenatal care for pregnant women from underserved settings

ABSTRACT

Introduction:

Telehealth has emerged as a promising supplementary modality in prenatal care. However, its impact on patient-provider communication (PPC), especially among pregnant women from underserved settings, requires comprehensive evaluation. This study examined the factors associated with the quality of patient-provider communication during the COVID-19 pandemic among pregnant telehealth users and non-users.

Methods:

Using a cross-sectional study design, 242 women were surveyed (response rate = 23%) regarding their experience with telehealth, quality of PPC, and experiences of discrimination during prenatal care. Multiple regression models were used to identify the factors associated with the quality of PPC during the COVID-19 pandemic. A sub-group analysis explored the factors associated with the quality of PPC separately among telehealth users and non-users.

Results:

The majority of the participants were on Medicaid (95%) and self-identified as Black/African American (57.3%). Regression analyses revealed a negative relationship between telehealth use during pregnancy and the quality of PPC (β = −1.13, P = 0.002). Irrespective of the telehealth use, the experience of discrimination was associated with poor quality of PPC among users (β = −3.47, P = .02) and non-users (β = −.78, P = .03), while adjusting for sociodemographic factors and social support during pregnancy.

Discussion:

While telehealth offers advantages like convenience, increased accessibility, and continuity of care, challenges in establishing effective PPC in virtual settings have emerged that emphasize the necessity for comprehensive provider training extending beyond technical competencies. The persistent issue of perceived discrimination, impacting PPC across both groups, underscores the necessity to rethink existing strategies of mandatory training to increase providers’ knowledge.

KEYWORDS:

• Telehealth
• prenatal care
• patient-provider communication
• discrimination

Acknowledgments

The authors thank Alexa Lopez, Allison Rady, Farzana Ali, Leonardo Gomez, Duane Herron, Greg Moore, Ellen Gaietto for their invaluable contribution to the data collection and execution of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

The first and second authors (MP and SS) contributed significantly to the conceptualization, study design, and execution of the research, including obtaining funding. They were also involved in data collection and analysis and were primarily responsible for writing both the original and final versions of the manuscript. The third and fourth authors (SS and GH) played key roles in data collection, contributed to writing parts of the original draft, and actively participated in the review and editing of the final draft.

Additional information

Funding

US Department of Health and Human Services, Health Resources and Services Administration, pass-through entity Lucas County Regional Health District. (CFDA Number and Name: #93.926, Healthy Start Initiative).

Notes on contributors

Mounika Polavarapu

Dr. Mounika Polavarapu is housed within the department of population health at the University of Toledo. She is trained in the etiological epidemiological approach, with her primary research interests in maternal and child health outcomes and their underlying disparities. She continues to examine the impact of the COVID-19 pandemic qualitatively and quantitatively on a variety of public health issues, including pregnancy experience and access to digital healthcare.

Shipra Singh

Dr. Shipra Singh from the department of population health at the University of Toledo is an expert in the intersection of clinical and public health and studies health disparities and health equity, emphasizing the impact of social determinants of health among vulnerable populations. Additionally, she examines the system-level factors in healthcare that contribute to health disparities with special attention to developing strategies to improve access and utilization of health services.

Shivangi Sharma

Shivangi Sharma is a third-year medical student at the University of Toledo who is interested in studying health disparities faced by pregnant women and understanding the impact of social factors on health.

Grace Hamilton

Grace Hamilton is also a third-year medical student at the University of Toledo, with research interests in health disparities among women and children influenced by the impact of social factors.