Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study

ObjectivesCare management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable.MethodsWe conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes.ResultsWe interviewed 33 women (10/2018-7/2021) and 24 clinicians (3/2021-8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability.Conclusions for PracticeDyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health. Unmet health care needs following complicated pregnancy influence future pregnancy outcomes and long-term women's health. Women have frequent contact with Pediatric settings between pregnancies. Pediatric care managers promote integrated, comprehensive care and may be able to support interconception health. In this qualitative study including women after preterm birth and clinicians, pediatric-based dyad care management, or care managers supporting mothers and infants jointly, was considered an acceptable intervention to support health care access and wellbeing of women after preterm birth. Acceptability was supported by the perceived flexibility of the intervention.