How health care setting affects prenatal providers' risk reduction practices: A qualitative comparison of settings

Background: We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks. Methods: We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors. Results: Practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO. Conclusion: Each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings.