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A socio‐ecological approach to understanding barriers to prenatal care for women of low income
Abstract
A socio‐ecological approach to understanding barriers to prenatal care for women of low income This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of low income. A socio‐ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as a social product and are consistent with the ideology of health promotion.
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People with low incomes may feel alienated by the power relations that often characterise encounters with professionals.
“Sword [56] points out that people with low incomes may feel alienated by the power relations that often characterise encounters with professionals.”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [56]
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Metadata
- Authors
- Sword, W.
- Affiliations
- McMaster University (CA)
- Corresponding author
- Sword, Wendy
- ORCID
- Sword, Wendy
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 1999-05
- Volume
- 29
- Issue
- 5
- Pages
- 1170-1177
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W1972206409
- Cited by
- 92
- References
- 50
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 3 · 2016: 3 · 2015: 8 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- prenatal care barriers, low-income women, socio-ecological model, health care utilization, health promotion, health care delivery, behavioural determinants, qualitative research, social determinants of health
- MeSH terms
- Female, Health Services Accessibility, Humans, Models, Theoretical, Poverty, Pregnancy, Prenatal Care, Socioeconomic Factors, Women's Health Services
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