Patient Access and Attitudes Toward Telehealth for Perinatal Care During and After the COVID-19 Pandemic in Georgia: An Exploratory Study Open Access

Abstract

Georgia has one of the highest maternal mortality ratios out of all the states in the United States of America. Maternal mortality is attributed to the quality of perinatal care and is exacerbated in rural populations. Literature on telehealth perinatal care access and satisfaction in Georgia is scarce, but there are even less resources applicable to pregnancy care during and after the COVID-19 pandemic. This thesis addresses gaps in knowledge on the access and attitudes of patients on their experiences with perinatal telehealth appointments, especially within different geographical locations within Georgia, U.S.A. To address this gap in knowledge, we screened 217 persons who were pregnant or gave birth during the 2020 COVID-19 pandemic in Georgia. The respondents answered 22 demographic, pregnancy care, and telehealth experience related questions. These questions were also used to ensure the respondents qualified as perinatal, whether present or past patients during the COVID-19 pandemic in Georgia to be interviewed. Then, 17 of these persons were interviewed in-depth using semi-structured mixed-method interviews. From the survey and interviews, the respondent care and residence locations were determined and analyzed. Rural patients receive more care in urban locations than rural locations. Generally, the interview respondents were both satisfied with their telehealth maternal care and willing to use telehealth appointments in the future, with no significant difference between rural and urban populations. Interview respondents reported satisfaction with their telehealth perinatal care because it reduced stressors, reduced indirect costs, and was easy to use in comparison to in-person appointments. Interview respondents also mentioned desired improvements to telehealth services including telehealth providers and locations supplying educational materials, strengthening the structuring of appointments, supplying at-home monitoring equipment, increasing visualization capacity within appointments, providing online perinatal support and education classes, and providing technology support. Based on these results, maternal care providers and perinatal legislation should account for what telehealth patients request to increase their satisfaction and access to telehealth services. However, due to the everchanging pandemic landscape, additional research is needed to further improve the understanding and suggestions of telehealth perinatal care at this scope.

Table of Contents

I. INTRODUCTION. 1

1.1 Introduction and Rationale. 1

1.2 Problem Statement. 2

1.3 Purpose Statement. 2

1.4 Research Questions. 2

1.5 Significance Statement. 2

1.6 Definition of Terms. 3

1.7 Acronyms. 5

II. LITERATURE REVIEW. 6

2.1 Maternal Mortality Overview. 6

2.2 COVID-19 Background. 9

2.3 Implications of COVID-19 on Pregnant Women. 10

Figure 1. COVID-19 cases by date of report in Georgia (Mar-Dec 2020). 11

2.4 Georgia Maternal Inequities. 11

2.5 Exacerbations in Rural Populations. 13

Figure 2. Available obstetrics provider services by Primary Care Service Area (PCSA) in Georgia in 2011 .. 15

2.6 Telehealth Background.. 16

III. MATERIALS AND METHODS. 18

3.1 Introduction. 18

3.2 Population, Sample, and Setting. 19

3.3 Research Design and Procedures. 20

3.4 Research Instruments. 21

3.5 Data Analysis Plan.. 22

3.6 Ethical Considerations. 23

3.7 Limitations and Delimitations. 23

IV. RESULTS. 25

4.1 Introduction. 25

4.2 Study Findings. 25

4.2.1 Findings: Access to Care. 26

Figure 3. Study Respondent Residence and Care Locations in Georgia. 26

Table 1. The total number of screener respondent and care classifications for those who provided location information. 27

4.2.2 Findings: Patient Perinatal Care Satisfaction and Willingness.. 27

Table 2. The willingness of interview respondents to use telehealth in the future. 28

Table 3. The satisfaction of interview respondents with their perinatal care experience. 28

4.2.3 Findings: Major Themes from the Qualitative Analysis. 29

Table 4. The most mentioned telehealth improvements that would make respondents more willing to use and satisfied with telehealth services for perinatal care. 31

V. DISCUSSION AND CONCLUSIONS. 33

VI. IMPLICATIONS, RECOMMENDATIONS, AND FUTURE DIRECTIONS. 36

REFERENCES. 39

 

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Obstetrics and Gynecology
Keyword	Access Attitudes Patient Pregnancy Telehealth Perinatal
Committee Chair / Thesis Advisor	Roger Rochat, Emory University
Committee Members	Morgan Clark-Youngblood, Emory University

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