Date of Award

8-16-2024

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

First Advisor

Nabil Natafgi

Second Advisor

Peiyin Hung

Abstract

Background: The United States (US) is experiencing a maternal health crisis, with rising severe maternal morbidity and mortality rates and persistent racial, ethnic, and geographic disparities. While telehealth can address access challenges, there is limited evidence of its impact on access to maternity care and outcomes among rural and minoritized communities. The overall objective of this study was to analyze the disparities in maternal outcomes and user satisfaction by hospital-based telehealth and obstetric care availability.

Methods: A convergent parallel mixed methods approach was used. A multinomial logistic regression was used to analyze whether the changes in the proportions of hospitals with telehealth and obstetrics capacity vary over time (between 2015-2020) by hospital rurality. To identify the relationship between educational attainment, race, and severe maternal morbidity (SMM), multivariable regression models were conducted. Furthermore, semi-structured in-depth interviews were conducted to understand factors related to amenability, user satisfaction, and experiences of rural and minority mothers using prenatal and hospital-based telehealth.

Results: Between 2015 and 2020, telehealth capacity increased among urban hospitals with obstetrics services while rural micropolitan hospitals with obstetrics services experienced a decrease in telehealth capacity. Hospitals without telehealth had stronger Black-White disparities in SMM (adjusted odds ratio (aOR, 1.46; 95% CI, 1.17, 1.83) compared to hospitals with telehealth (aOR, 1.21; 95% CI, 1.04, 1.40) (p=.031). However, educational (master’s or higher versus high school or less) disparities were stronger among hospitals with telehealth (aOR, .57; 95% CI, .40, .80) compared to those without telehealth (aOR, .77; 95% CI, .67, .87). Birthing individual’s amenability to telehealth was affected by factors such as accessibility, convenience, continuity of care, and avoidance of discrimination and judgment encountered during in-person visits. Participants expressed mixed views about satisfaction with the pregnancy-related visits. Challenges of telehealth were primarily technical difficulties and the limited relationship that the modality allows the patient to have with the provider. Conclusion: This study provides essential information related to pregnancy-related telehealth that can be utilized to develop innovative and targeted solutions to improve outcomes and reduce disparities in maternal health nationwide, particularly among vulnerable populations.

Rights

© 2024, Shanikque L Barksdale

Available for download on Sunday, May 31, 2026

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