Validating a path model of adherence to prenatal care recommendations among pregnant women

Patient Educ Couns. 2019 Jul;102(7):1350-1356. doi: 10.1016/j.pec.2019.02.028. Epub 2019 Mar 1.


Objective: To date, no study has reported a diagrammatic path model that involves patient-provider communication on pregnant women's adherence to prenatal care recommendations. To bridge this gap, this study aimed to validate a path model to display the direct and indirect influences on adherence to prenatal care recommendations.

Methods: A cross-sectional study founded on an evidence-based proposed theoretical framework was conducted among pregnant women (18-45 years) in their second or third trimester (n = 401) in the Midwestern United States. The proposed theoretical framework examined multiple levels of influences. Previously validated instruments were pilot tested and modified. Path analysis was conducted to validate the best-fit path model.

Results: The path model showed shared decision-making and motivation significantly predicted adherence to prenatal care recommendations and accounted for 10% (R2) of the variance. Cultural competency, interaction, perceived discrimination, and satisfaction accounted for 30% (R2) of the variance of shared decision-making. Patient's trust, distrust, and self-efficacy accounted for 5% (R2) of motivation's variance.

Conclusion: Our work identified the best-fit path model for adherence to prenatal care recommendations.

Practice implications: Incorporating findings from this study could assist prenatal care providers in understanding many complex variables affecting prenatal care, ultimately reducing infant mortality.

Keywords: Adherence to prenatal care recommendations; Best-fit path model; Patient-provider communication.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Cultural Competency
  • Decision Making, Shared
  • Evidence-Based Medicine
  • Female
  • Humans
  • Middle Aged
  • Midwestern United States
  • Models, Theoretical*
  • Motivation
  • Patient Acceptance of Health Care*
  • Pregnancy
  • Pregnant Women*
  • Prenatal Care*
  • Self Efficacy
  • Trust