Assessing the Obstetric Patient’s Knowledge of Pregnancy

Purpose: Anecdotal evidence suggests a majority of patients in our urban, county hospital setting are lacking in their knowledge and understanding of pregnancy. Tarrant County has an increasing infant mortality rate which is higher than state and national rates. Currently, there is no consensus regarding what minimal basic knowledge obstetrical patients are encouraged to know regarding pregnancy. Centering pregnancy is a new model of antenatal care that integrates health assessment, education, and support through group-based meetings and facilitated discussions. This setting may be more conducive to patient education than traditional prenatal care. A survey was designed in attempt to assess and establish a baseline of our obstetric patient population’s level of knowledge regarding pregnancy. Methods: A questionnaire was developed to collect patient demographic information and assess basic knowledge. The knowledge-based questions were designed based on patient education materials available from ACOG and a consensus of providers from our department. The questions focused on modifiable maternal risks factors found to have the highest correlation to infant mortality in Tarrant County. Questions assessing knowledge utilized a Likert scale response. Patients self-reported whether they received traditional, Centering Pregnancy, or no prenatal care. Univariate statistical analysis was performed on the demographic information. For analysis of the knowledge-based questions, a score was given based on the sum of items correctly responded. Results: From July to August 2014, 150 surveys were completed by patients on their first postpartum day. 6.5% reported they did not receive any prenatal care and the remaining respondents received care from a physician, nurse practitioner, or midwife. 24% of those who received prenatal care attended Centering Pregnancy. 44% reported they learned most of their pregnancy information from family and friends versus 36% from a clinical provider. 45% were high school graduates. For the knowledge based questions, 46.9% of the respondents answered 80% of the questions correctly. The average score for the entire sample was 72.9% correct. Respondents who received traditional care had a score of 73.5% correct versus Centering Pregnancy with 70% correct. Respondents scored higher on questions regarding health and social behavior questions such as diabetes, hypertension, smoking, and drug use, compared to questions pertaining to the postpartum period or self-perception. Conclusions: Information concluded from the study allows providers to better understand our current patient population’s basic knowledge of pregnancy. There appears to be a better recognition of health and social risks factors affecting pregnancy such as smoking, drug use, diabetes, and hypertension. Deficits in knowledge, such as aspects regarding the postpartum period, were better identified, which will allow providers to tailor their antepartum and postpartum patient education. Providers do need to recognize that patients heavily rely on family members for pregnancy information. Though the patients who received Centering Pregnancy received a slightly overall lower knowledge score, as the sample size of patients who received Centering Pregnancy was small, a direct correlation cannot be drawn. The average knowledge score of 72.9% correct offers a baseline standard on to which we can assess for improvements in patient education in future studies. In improving basic patient knowledge and affecting modifiable risk factors, providers can potentially impact the infant mortality rate.