My research won first place at the COEHP Honors Research Symposium this year!

Author: Savannah Busch | Major: Public Health

Throughout the spring 2022 semester, I completed thesis work to fulfill honors requirements for Public Health majors in the Health, Human Performance, & Recreation Department of the College of Education and Health Professions. My work is titled “Social Determinants Associated with Prenatal Visits at a Community Health Center” and was completed under the supervision of Dr. Hammig.

My research journey began in Fall of 2021 when I was a Public Health outreach intern at the Community Clinic in Springdale. Three days a week I worked at the headquarters alongside public health outreach professionals to complete a variety of tasks designed to educate and interact with the Springdale community, specifically our Hispanic and Marshallese patients. This is also where I was introduced to the PRAPARE tool. It is a survey toolkit that was designed by the National Association of Community Health Centers to measure the social determinants of health of patient cohorts. Social Determinants of Health are factors such as language, race, and education that affect the health outcomes of patients. The survey was in use for measuring social determinants and the likelihood of receiving a COVID-19 vaccine. My job as an intern was to help write an introduction and background to a journal article discussing the use and application of this tool, and to code the results so they could be inputted into statistical analysis programs. This exposure to PRAPARE is what influenced the path I took with my thesis.

I have always been interested in prenatal care as it ties together my interest in medicine and public health. Proper prenatal care is important to both the health of the mother and child, as well as communities, as development relies on the healthy growth of a population. My research could potentially serve as a foundation to implement upstream, evidence-based public health interventions. Thus, I knew I wanted to use the PRAPARE tool through the lens of prenatal care. With the help of Dr. Hammig, who is familiar with the work being done at the Community Clinic and the PRAPARE tool, I developed my research question. I wanted to know if there was a connection between social factors and delaying of initiation of prenatal care in this patient population.

My research was done independently while relying on Dr. Hammig and my intern preceptor at Community Clinic for guidance with any questions. The first step was to create a thesis proposal. I learned all the parts of a research paper and how to cite references using citation programs. My thesis proposal ultimately led me to be awarded with an Honors College Research Grant for the spring 2022 semester. Then, I began to code and analyze the data that I had received from Community Clinic. Dr. Hammig taught me how to code qualitative data into numerical systems and categorize answers into comparable quantities. I had never done anything like this, so it proved to be difficult at first. Yet, the data slowly started to make sense and I got some interesting results.

Standard prenatal care includes 8 prenatal visits with ultrasounds spread out among the three trimesters. Out of the 345 participants in the study, only 11.6% (N=40) received an ultrasound during their first trimester. However, the average number of women that initiated a prenatal appointment (and ultrasound) in the first trimester in the United States in 2016 was 77.1% of women and 68.4% of women in Arkansas (Osterman & Martin, 2016). Clearly there is a disparity, and I used PRAPARE to try to understand the causes. Unfortunately, though, there was no associated social risk calculated by the survey that connected with delaying prenatal care. Yet, specific factors like education, insurance status, unemployment, minority status, and primary language were somewhat significant. This led me to conclude that the PRAPARE tool is not suitable to be used on this population. The participants are homogeneous in their diversity so were all found to not have social risks, when in fact they do in comparison to the whole of the Northwest Arkansas community.

I learned a lot while completing this research. Primarily it taught me to think critically and creatively. My data did not lead me where I initially thought that it would, so I had to delve a little deeper to hypothesize reasons for that. This research grant allowed me to do research on a topic I am passionate about and plan to continue in the future. I am attending medical school at UAMS where I hope to continue studying patterns of prenatal care in different populations to figure out how to help Arkansas women receive more prenatal care.