Date of Graduation


Document Type


Degree Name

Bachelor of Science

Degree Level



Health, Human Performance and Recreation


Hammig, Bart

Committee Member/Reader

Dobbs, Paige


Background: Understanding the barriers to prenatal care could have implications for community health initiatives, as early initiation of care is vital to maternal and fetal health. Social factors that impact health outcomes and behaviors, such as prenatal care, are referred to as Social Determinants of Health (SDoH), and studying the combined effects of multiple SDoHs is a newer method to identify a specific population’s needs. Purpose: This study explores the associations between SDoH and the initiation and number of prenatal appointments in a cohort of women receiving care at a local community health center (CHC). Methodology: The study retrospectively analyzes the reported SDoHs of a group of 345 pregnant women that received care at the CHC between January 2019 and December 2020. SDoHs such as income, insurance status, and education were gathered at the CHC by staff members at the time of patient visits using the 22 question Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) toolkit. Responses were deidentified, numerically coded, and stratified into overall risk categories of low, moderate, high, and urgent based on number of standard deviations above the mean. The researcher collected quantitative data for individual characteristics, parity, trimester of prenatal care initiation, and the 4 categories of questions within the toolkit: personal characteristics, family and home, money and resources, and social and emotional heath. Results: Ninety-one women in the study classified as having high or urgent risk (26.3%), with 79.7% (N=275) reporting moderate to high levels of negative social and emotional health. Of the 345 subjects, 11.6% (N=40) had an ultrasound during the first trimester. Regarding the demographic characteristics, over 50% of participants spoke a language other than English, identified as Hispanic or Latino, used public insurance options, had a high school diploma or less, or were employed part-time or unemployed. A logistical regression showed a weak, but positive, association between risk scores and occurrence of ultrasounds throughout the pregnancy. Discussion: Subjects in this study had fewer first trimester ultrasounds than their counterparts in the United States and Arkansas. Moreover, most participants demographic characteristics meet many of the barriers supported by literature, inclusive of race/ethnicity, language, education level, and insurance. Yet, PRAPARE scores were not associated with a substantial number of high and urgent risk participants. This study found that the PRAPARE toolkit may not be applicable to pregnant women’s’ risk of delaying prenatal care at predominately low-income CHCs, possibly due to the lack of pregnancy-related questions. Instead, data from individual questions and categories could be used to guide interventions. Suggestions include emotional support groups to reduce maternal stress and an increase in multilingual resources to reduce language barriers.