Beyond bus fare: deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study.
Joan Rosen Bloch, Sarah Cordivano, Marcia Gardner and 1 others
PMID 29969975WHAT IT FOUND
A modeled low-income Philadelphia mother with high-risk pregnancy was estimated to spend 25.5 hours on public transit, travel 243.6 miles and pay $115.20 in tokens for prenatal and related visits, and a 30-minute delay could force her to reschedule.
Key findings
01For the modeled high-risk pregnancy, the estimate was 32 appointments, 25.5 cumulative hours, 243.6 total miles and $115.20 on public transportation.
02In the hypothetical case, a 30-minute bus delay caused a late arrival, and the clinic said appointments more than 15 minutes late must be rescheduled.
03The modeled travel totals excluded waiting for late buses, walking to stops, time at facilities and service time, so they are underestimates.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used one hypothetical mother, so the travel totals are not measured from a real patient and may not represent other neighborhoods or cases. The birth data used to identify the neighborhood came from 2003 to 2005, though the authors say the built environment and service locations have not changed. The travel estimates excluded waiting for late buses, walking to stops, time at facilities and service time, so they underestimate the total burden. The model did not include weekly progesterone injection visits because many mothers receive them from home visiting nursing services. Costs could be higher for women paying cash or traveling with children over 60 inches tall.
The easy way to misread this
Do not read Tara as a real patient or the totals as measured outcomes. They are modeled from one hypothetical address, and the study does not show that changing clinic policy or providing bus tokens improves prenatal care.