'Breaking It Down': Patient-Clinician Communication and Prenatal Care Among African American Women of Low and Higher Literacy

PURPOSE: Low literacy has been associated with poor medical adherence, but its role in maternal care utilization has not been explored. METHODS: We undertook a concurrent mixed methods study among 202 African American women of low (.05). Cultural consensus analysis identified a single prenatal care factor that was comprised of 9 items, shared by women of low and higher literacy (eigenvalue 0.881, SD 0.058). Focus groups confirmed these items among participants from both literacy groups. Communication with clinicians was a central theme linking all of the factor items. Effective communication, exemplified by "breaking it down," was described as encouraging, whereas ineffective communication discouraged use of care. CONCLUSION: Women who had both low- and higher-literacy skills had high rates of poor prenatal care utilization and reported that communication with clinicians influenced their use of prenatal care. Improving the clarity of communication by breaking down information into simple parts should be a priority for prenatal clinicians.