Discordance Between Perinatal Home Visiting Nurses and Diabetic Pregnant Women's Health Concerns During Pregnancies in Philadelphia
Authors:   , Brown Yaadira , Turchi Renee 
Published: July 2021

Background: Maternal mortality and morbidity are worsening in the United States with documented racial and ethnic disparities. Home visiting models of care for urban high-risk MCH populations are expanding as an evidence-based approach to improve maternal-infant health. Surprisingly, with increasing prevalence rates of chronic, non-communicable diseases (e.g., diabetes, hypertension), minimal attention has been given to urban populations of pregnant women with diabetes and hypertension that may be receiving home visiting. Diabetes and hypertension are serious complications of pregnancy necessitating more intensive medical and nursing management. To promote optimal health and prevent serious complications, obstetricians in the Philadelphia area can refer medically-high risk pregnant women to perinatal nursing home visiting services. Within the home environment, nurses assess bio-psychosocial health and tailor nursing services and teaching to optimize health and health outcomes. Because little research attention has been given to this particular evidence-based transitional care model (TCM) of perinatal nurse home visiting services, an academic-community-based partnership was formed to study the utilization, processes, and outcomes of this model of perinatal nurse home visiting as it exists today. It was initially studied in the 1980s at the University of Pennsylvania. Our initial analyses revealed that 595 pregnant women in the Philadelphia area were referred for TCM perinatal nurse home visiting services during 2012. Multiple visits were authorized during the pregnancy. An interdisciplinary perinatal health disparities research group is currently asking research questions of data that exists in a REDCap research database, which was developed from record abstraction of the agency's perinatal nurse home visiting health records. Study Questions: What were key nurses' and patients' concerns documented on the health forms during perinatal nurse home visits? Study Population and Setting: The sample consisted of 139 pregnant women who received perinatal nurse home visits (n = 781 visits) because of their diabetes. All visits took place during 2012 from an independent perinatal nurse home visiting community-based program that serves the Philadelphia area. The mean weight was 221 pounds (range 124 -472 lbs) among the women that received this specialized perinatal home visiting services. Methods: This was a qualitative analysis using content analysis of narrative data extracted from existing health records of perinatal nurse home visiting services. The community-based perinatal agency's health form was developed by using the Omaha System, a research-based, comprehensive practice and documentation standardized taxonomy. The Omaha System is the gold standard for health information documentation for nurse home visiting services used in various populations across the life span. In this agency's health forms, separate narrative fields exist to record narrative data of the comments that are not captured elsewhere on the health forms that are mostly check-off fields. These narrative data were extracted from the REDCap database for this content analysis. Results: Of the 781 home visits, there were a total of 484 special narrative notes (134 general comments, 296 general nurse concerns, and 54 general patient concerns/goals). The content analysis revealed that nurses and pregnant women mutually shared concerns about the challenges in self-management of diabetes. Written concerns of pregnant women included their worries about their baby's health. However, although 41% of the nursing comments pertained to the patients' obesity, this was not documented in any of the patient concerns. Conclusion: The discordance in concerns over obesity between home visiting nurses and pregnant women receiving services because of diabetes and hypertension has important public health implications. Most of the women were morbidly obese and did not voice it as a concern. Population-level interventions need to consider health beliefs and attitudes of obesity.