The purpose of this project is to refine, implement and evaluate an empirically derived community-based nursing practice model with specific nursing interventions for providing prenatal care services to Hawaiian, Filipino, and Japanese women living in the Hilo-Puna district on the island of Hawaii. The goal is to complement standard prenatal services with community outreach to increase access and retention using culturally sensitive strategies congruent with the Hawaiian island style of these women. Desired outcomes during participation in the community-based prenatal care program (CHN-PCP) ar to improve the pregnancy-postpartum adaptation of these women through: reduced incidence of low birthweight infants, increased gestational ages of newborn infants, reduced obstetrical-neonatal complications and their associated financial costs for prolonged hospitalization stay; increased maternal health promotion behaviors demonstrated by use of health care services; and increased sense of meaning, mastery, and self-esteem. The study will be conducted in two phases: needs assessment, and then program implementation and evaluation.
Study aims are to describe stresses and the cultural meanings of childbearing for these women; and to evaluate effectiveness of the CHN-PCP for (a) quality of care, as measured by psychological and cognitive adaptation scores; (b) patient outcomes, as measured by disease prevention and health promotion scores; an (c) costs and benefits as measured by the medical costs for maternal-neonatal care. The innovative CHN-PCP involves a total of 19 program visits beginning from 10-14 weeks gestation to 3 months postpartum for a total of approximately 10 months contact with each subject. Program visits involve interaction with nurses, community outreach workers through a female Neighborhood Health Watch, ethnic healers, neighborhood women as buddies, and local business leaders. Four groups of childbearing women are targeted for comparative analyses; baseline birth certificate data group (BD) before the CHN-PCP begins, a prior comparison group (PC) sampled in the first year during the needs assessment, women who participate in the CHN-PCP, and a group of non participants (NP) obtained during the time period the CHN-PCP is operating. The final CHN-PCP sample will be 150 women. Differences in the desired outcomes between CHN-PCP participants and each of the comparison groups will be analyzed through multivariate analysis of variance. Specific cost analyses procedures will be conducted.
