I have returned with comments all the papers that have been sent to me as drafts for part 1. Now our job is to get them finished as part 1 and put the completed perfect paper aside and prepare part 2

Below is the format for the review of literature. I will give you an abbreviated version. Note how the key words are included; and how the literature review will be separated. I have cut it off so that it is not too long but gives you a flavor for how to structure the literature review. You should have a minimum of 8 articles or references.

Review of the Literature

A literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Google Scholar Advanced, Ovid, Crozer Virtual Library, and the CDC. A total of 112 articles were retrieved, and 48 articles were reviewed. Recent textbooks provided supportive information. Articles were eliminated that noted target

population differences or small samples. Studies were limited to recent literature (2015-2020) except in situations where the article reviewed was invaluable to the research to be undertaken. Key words guiding the query included: prenatal care, gestational age, high risk care, barriers to prenatal care, preterm birth, needs assessment of pregnant women, perinatal outcome, access to prenatal care, low birth weight infants, adequate prenatal care, health disparities, health literacy, and no prenatal care. This literature review is divided into three topic areas: Prenatal Care Models, Barriers to Prenatal Care, and Preterm Birth. Note:(see how each of the above sections are identified) This is bolded for emphasis for you to review. This was the way my final paper separated a large amount of references. You can use this if you see it as being advantageous for the layout of the paper.

Prenatal Care Models. using et al tells me there was more than 5 authors to this article. Followed was a brief review of the important aspects of the article that made me select it.

Ickovics et al. (2007) conducted a randomized controlled trial (RCT) utilizing two hospital-based clinics. The population studied ranged in age from 14 – 25 years of age (n= 1,047). One group of women was from Atlanta (n- 546) and another from New Haven (n=503). The women were randomly assigned to standard prenatal care or group prenatal care. The timing of visits followed the usual schedule at the completion of the first trimester. The women assigned to group care had an estimated date of delivery similar to each other. They were assigned a two hour block of time during which they would have their regular visit plus additional services. Each of the sessions included physical assessment, education related to common discomforts of pregnancy and support through group discussion on topics related to finance (insurance or other payment options) or pregnancy-related psychological issues. The women assigned to regular prenatal care met at the scheduled appointment time for routine prenatal care, but they did not have the additional social and educational support that was offered in the group prenatal care. Each of the two assigned groups met with their care provider privately. The mean age for the participants was 20.4 years (SD 2.6), 80% of the women were African American, 49% were age 14-19 years, 38% had completed high school and 26% dropped out of school. Thirty one percent were currently employed. Women assigned to group care were significantly less likely to have a preterm birth (9.8% compared to 13.8%), which represented a significant risk reduction of 33%. Women in group prenatal care were less likely to have inadequate care and had significantly better perinatal knowledge. They reported feeling more ready for labor and delivery and were satisfied with their care. Breastfeeding was initiated more with women who had group prenatal care as compared to those who received routine prenatal care (66.5% compared to 54.6%). Group prenatal care also resulted in improved perinatal outcomes at no increase in cost. The longer the group care women were exposed to the positive environment and support, the longer the gestation and the higher the birth weight. The study population was from a disproportionately lower socioeconomic status, and that population is significantly at risk for poor perinatal outcomes. The group care results were encouraging. The researchers concluded that the mechanisms instituted in the group care, that resulted in positive

Cramer, Chen, Roberts and Clute (2007) described the evaluation and findings of a community-based prenatal care program that was designed to reduce racial disparities in birth outcomes. The study used a comparative descriptive design that evaluated the impact of enhanced community-based services over a two year period. A total of 236 women enrolled in the study. Preliminary analysis of data indicated that prenatal case management and community outreach can improve birth outcomes for minority women, while producing cost savings. The community outreach program consisted of minority women who identified and enrolled pregnant women in the community. Participants were assigned to case managers, and received weekly home visits, office visits or telephone calls. The case managers linked the participants with medical homes, which insured transportation, screening and referrals for risk factors. The results of the two year study were that birth outcomes were improved (significant improvement in low birth weight infants and infant deaths) and a 31% cost savings associated with hospital related costs was realized. The authors recommended that a community-based prenatal programs be initiated that would provide services to all women who may experience local racial disparity when seeking prenatal care.

Barriers to Prenatal Care

Friedman, Heneghan and Rosenthal (2009) undertook a study of the records of 211 women who did not receive prenatal care, but were admitted to the hospital for delivery. If the delivery occurred outside the hospital, the women were seen in the postpartum period for care after delivery. The characteristics of the women who did not receive prenatal care, and their reasons for not accessing care included the following; substance abuse (64 women), financial issues (37 women), concealed or denied the pregnancy (81 women), and multiparity (12 women). Seventeen women gave other reasons. Substance abusing women were older, multiparous and

Preterm Birth.

Behrman and Butler (2007) undertook an extensive review of protocols and research to gather data to pinpoint the root cause of preterm labor and birth. Barriers to clinical research on the causes of preterm birth were analyzed in depth. Policies that focused on providing care to women with preterm labor were analyzed and modified as needed to address possible causes and formulate solutions for preterm birth. Preterm birth is a major health care problem in the United States and globally. Dr. Behrman stated that” this health problem is poorly understood but interrelated with the many biologic, psychologic and social factors that are expressed in a common pathway ending in preterm birth”. The Institute of Medicine (IOM) and many other government and private agencies have joined forces to address issues related to preterm birth. For years health care has focused on stopping contractions, and that has not changed the outcome. Psychosocial issues remain a major factor in the etiology of preterm birth, but psychosocial factors are difficult to measure due to their complexity, and the potential for distortion. Social support did not surface as a reliable predictor of prevention for preterm birth, but the wantedness of the pregnancy did become a factor. Women who experience unwanted pregnancies tend to forego prenatal care. “Preterm birth is not one disease for which there is likely to be one solution or cure….preterm birth (is) a cluster of problems with a set of overlapping factors of influence that are interrelated. This complexity makes the detection of solutions to the problem difficult. There will be no silver bullet” (Behrman & Butler, 2007, p.5). The data that was received from multiple sources describing the adequacy of diagnosis and treatment of women at risk for preterm birth led the committee to make the following recommendations: establish multidisciplinary research centers, define the problem, initiate clinical and health services research, and determine the etiology and epidemiology of preterm birth (Behrman & Butler, 2007, p.2).

After you complete your lit review – add this final section directing the approval by IRB, etc. In your case the Institutional Review Board (IRB) of Lincoln University.

Methods

Data collection will be undertaken after approval for the study is obtained from the institutional review boards of the Crozer Keystone Health System and Marymount University. A non-experimental survey design was selected to collect the data. This survey will be used to obtain descriptive data to assess the needs of a population of pregnant women attending an inner city obstetric clinic. The needs assessment will take the form of a list of preferences for the proposed additional services under consideration for addition to the clinic. The survey had two parts: first part will be administered in the last trimester of pregnancy during a clinic visit, and the second part (slightly revised) will be administered on the patient’s first postpartum visit. The sample size was determined using a one tailed t test power analysis with a significance level of .05, an effect size of .40 to obtain power of .80.