Examining digital care relationships of medicaid participants in the pre/postnatal care period: a qualitative study

Abstract

Abstract Background Underserved populations in the United States are at higher risk for poor maternal health outcomes. New models of care, such as telehealth, can offer additional support, including access to care 24/7/365 days a year; however, little is known about their impact on nurse-patient relationships. This study aimed to explore the perspectives of patients and nurses (registered and advanced practice registered nurses) on the relationships established through a telehealth program for pregnant and postpartum women. Methods A qualitative, descriptive, longitudinal study was conducted between December 2022 and December 2023. Semi-structured interviews were completed with 28 individuals in the first year after the program’s launch. Among the participants, 23 were pregnant or postpartum women enrolled in a pregnancy and postpartum support program, and five were nurses involved in delivering the program. The semi-structured interviews were conducted remotely using a phone or an online platform. The interviews were analyzed using thematic analysis. Results Two major themes, Therapeutic Nurse-Patient Relationships and Programmatic Aspects that Support Virtual Relationships, along with twelve subthemes, were identified. Participants felt that the programmatic aspects allowed them to create meaningful relationships with their care providers. In addition, the digital services offered a nonjudgmental and supportive method for women to receive care and education when and where they need it. From the nurses’ standpoint, they felt that they could personalize the care for women without the time limitations typical in an in-person clinical encounter. Conclusions Supporting women through digital models of care can influence their engagement and relationships with their nurses. Findings show that both the women and the nurses reported being able to establish positive relationships, although they described them differently. As a result, women reported feeling comfortable accessing care and asking pregnancy-related questions, suggesting that telehealth programs can foster the development of therapeutic nurse-patient relationships.

Keywords

• Pregnancy
• Postpartum
• Text messaging
• Telehealth
• Nurse-Patient relations