Examining the Perceived Quality of Person-Centered Maternity Care (PCMC) in Prenatal Telehealth Services during the COVID-19 Pandemic in Georgia: A Qualitative Study Open Access

Rosales, Cindy (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/th83m055s?locale=en


BACKGROUND: Maternal Mortality is a core health indicator used to track the overall health status of a population. While globally, the maternal mortality ratio has declined over the past eighteen years, the United States (U.S.) maternal mortality ratio has more than doubled since 1987. Georgia has the second-highest maternal mortality ratio in the U.S. To address the maternal mortality crisis and expand access to care, the healthcare model has integrated telehealth. Recently, the COVID-19 pandemic has catalyzed the sweeping adoption of telehealth in maternity care. Yet, there is limited understanding of how providers and healthcare facilities have adapted to prenatal care recommendations and how women have perceived the quality of these changes during prenatal telehealth appointments. 

OBJECTIVE: This qualitative study examined the perceived quality of person-centered maternity care (PCMC) in prenatal telehealth services during the COVID-19 pandemic among women in Georgia. Specifically, this study sought to understand how patients experienced the patient-provider relationship within the context of the following PCMC domains: dignity/respectful care, autonomy, privacy/confidentiality, communication, social support, supportive care, and trust. 

METHODS: Seventeen women living in Georgia between the ages of 18-45 years participated in semi-structured, in-depth interviews via Zoom. Eligible patients had to receive prenatal care in-person and through telehealth during the COVID-19 pandemic (March - November 2020) in Georgia. Patients were excluded if they did not speak English, we're unable to consent and had no prenatal telehealth experience. Patients reflected upon their experiences and interactions with their prenatal care provider(s) during both in-person and telehealth appointments. Data were analyzed using thematic analysis. 

RESULTS: Patients represented both urban and rural counties in Georgia. Most women identified as white (65%, N=11), over a third were college graduates (76%, N=13), and for 47% of women, this was their first pregnancy (N=8). The following three themes emerged: 1) Telehealth is a medium to relieve COVID-19 anxiety during pregnancy care, but it presents challenges to patients perceived privacy and trust of their providers; 2) COVID-19 has changed how prenatal care is accessed and delivered, but the patient-provider relationship remains central to the quality of care; 3) Telehealth increased patient’s comfortability accessing prenatal care and communicating with their provider. 

CONCLUSION: This study’s findings show the emotional, structural, and social impact the pandemic has had on the access and delivery to prenatal care and the perceived quality of PCMC. The findings from this study present an opportunity to create clinical practice guidelines that can guide infrastructure and workforce changes needed to standardize and integrate telehealth into perinatal care models. Also, the findings from this study may provide a model for future researchers to conduct longitudinal studies aimed at measuring the quality of PCMC in telehealthcare during pregnancy and postpartum. 

Keywords: Telehealth, prenatal care, person-centered care, person-centered maternity care, COVID-19 

Table of Contents

Chapter I – Introduction

Purpose Statement & Research Questions


Significance Statement

Chapter II – Literature Review


Quality of Care


Novel Coronavirus (COVID-19) Pandemic

Purpose Statement

Chapter III: Student Contribution

Overview of the EGHI Telehealth Project

Role of Student with EGHI Project

Project Design

Data Collection Instruments

Recruitment & Data Collection

Data Analysis

Student Contribution to Thesis

Chapter IV - Manuscript


Purpose Statement & Research Questions


Significance Statement


Study Design

Sample and recruitment

Data Collection

Analytic Method

Ethical Statement



Strengths & Limitations

Future implications ideas


Chapter V – Public Health Implications

A Call for Evidence-Based Telehealth Guidelines

A Call for Future Research



Appendix A – WHO framework for the quality of maternal and newborn health care

Appendix B - Person-Centered Care Framework for Reproductive Health Equity

Appendix C – Interview Guide

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