Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, Text Messaging,

Intervention Description: Navigating New Motherhood (NNM) was a patient navigation program that sought to increase the frequency of postpartum care attendance in a tertiary care center practice serving predominantly low-income, minority women. The NNM program provided postpartum appointment scheduling assistance, appointment reminders, assistance with logistical barriers, and social support to mothers. In accordance with patient preference, the NNM program relied predominantly on SMS text message communication between patient navigators and women enrolled in the program.

Intervention Results: While the program was in place, the majority of enrolled women (88.1%) returned for their postpartum visits at an average of 6.2 weeks postpartum. More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p<0.001 and 11.5 vs. 8.0, p<0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13–7.41). Lack of patient response was also associated with lack of follow-up (p<0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p<0.01 and p<0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p=0.01).

Conclusion: Findings illustrate that certain communication characteristics, including more frequent exchange of messages and greater use of rapport-building- or maternal health-oriented messages, are associated with an improved likelihood of return. Message frequency and message content appear to be critical communication features of effective patient navigation. Rapport-building messages were the most frequently observed type of communication across all message threads, and they were significantly more frequent among patients who ultimately completed follow-up. These results are consistent with previous studies emphasizing the importance of relational qualities and the ability to build trust within the patient navigation model

Study Design: Mixed methods secondary analysis

Setting: University tertiary care center in Chicago

Population of Focus: Women enrolled in public insurance receiving prenatal care

Sample Size: 218 women

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, Text Messaging,

Intervention Description: The patient-centered Navigating New Motherhood program hired one full-time patient navigator who was experienced navigating low-income women through women's health cancer screening and treatment. The navigator coordinated with clinic staff to schedule the patient's six-week postpartum appointment as well as any earlier visits recommended by the medical team. Appointment times were communicated in person or by phone, text, or email, per patient preference. Reminders were sent by the navigator one week after delivery, one week prior to appointment, and one day prior to the appointment. The navigator offered additional services as needed, including connection to health care providers for maternal or neonatal clinical concerns, psychosocial support, appointment and logistical support, assistance with social work needs (such as identifying food or transportation resources), or connection to mental health care providers. Additionally, during the postpartum hospitalization, the navigator offered brief written and verbal counseling about the benefits of and options for contraception and breastfeeding.

Intervention Results: The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% compared with 70.3%, P<.001), a difference that persisted after adjustment for potential confounding factors. Women in Navigating New Motherhood were also more likely to receive a WHO Tier 1 or 2 contraceptive method, postpartum depression screening, and influenza and human papillomavirus vaccination.

Conclusion: Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

Study Design: Prospective observational study

Setting: Medicaid based university clinic

Population of Focus: Patients receiving prenatal care

Sample Size: 218 in intervention group; 256 in historic cohort

Age Range: ≥18 (29 mean age)