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Published in final edited form as: Matern Child Health J. 2023 Nov 19;28(2):351–361. doi: 10.1007/s10995-023-03848-5

Acceptability of dyad care management after preterm birth: A qualitative study

Emily F Gregory 1,2,3, Rinad Beidas 4, Alexander G Fiks 1,2,3, Scott A Lorch 1,2,3, Lisa D Levine 5, David M Rubin 1,2,3, Adya I Maddox 2,3, Ann L O’Sullivan 6, Katherine Wu 3, Peter F Cronholm 3,7
PMCID: PMC11197049  NIHMSID: NIHMS1999599  PMID: 37980700

Abstract

Objectives:

Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable.

Methods:

We conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes.

Results:

We interviewed 33 women (10/2018 – 7/2021) and 24 clinicians (3/2021 – 8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability.

Conclusions for practice:

Dyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health.

INTRODUCTION

Birth outcomes are worsening in the United States and demonstrate racial inequities (Hoyert, 2020; Louis et al., 2015; Osterman et al., 2023). In recent years, Black birthing people were three times as likely to die from pregnancy-related causes as White birthing people, and twice as likely to deliver prematurely (Hoyert, 2020; Louis et al., 2015; Osterman et al., 2023). Most maternal mortality is considered preventable (Shapiro-Mendoza, 2016; Srinivas, 2020).

Addressing health in the interconception period, which lasts from one birth to the start of a subsequent pregnancy, may improve outcomes and reduce inequities for the 60% of births that are repeat births (Gregory et al., 2022; Osterman et al., 2023; Shapiro-Mendoza, 2016; Srinivas, 2020). However, as few as 60% of Medicaid-insured women have preventive visits for themselves in the year after birth, with gaps in both primary and secondary prevention (Bennett et al., 2014; Gregory et al., 2020; Lewey et al., 2020; Rankin et al., 2016). Barriers to interconception health care include lack of care team continuity, inadequate education about the rationale for preventive care, and logistical challenges such as childcare and transportation (Bennett et al., 2011; Rodin et al., 2019; Tully et al., 2017; Verbiest et al., 2018).

Gaps in maternal care have encouraged strategies to promote interconception health through infant visits (Srinivasan et al., 2018; Upadhya et al., 2020). While this approach may remove some barriers for parents, pediatric clinicians report challenges to providing interconception content including inadequate time and inadequate referral support for identified needs (Venkataramani et al., 2017).

Family and clinician barriers to interconception care are analogous to barriers to integrated care for individuals with medical complexity. To integrate care for individuals, health systems have developed programs such as care management (Kuo et al., 2018), which has been defined as a “team-based, patient-centered approach designed to assist patients and their support systems in managing medical conditions more effectively” (Agency for Healthcare Research and Quality, 2015). Care management programs vary by design, tailored to the needs of specific populations (Agency for Healthcare Research and Quality, 2015). In pediatrics, these programs already provide services to some children born after complicated pregnancies or prematurity. Maternal needs are also increased in these situations (Bergman et al., 2020; Cohen et al., 2011; Mosca et al., 2011). We use the term dyad care management to describe care management services provided for both parent and child through a single team.

Care managers based in infants’ medical homes may be well positioned, in terms of skillsets and existing relationships, to promote interconception health after complicated pregnancies. In addition, in some pediatric settings, these programs have established funding through quality payment arrangements. Growing interest in payments for doulas and community health workers may provide new funding streams for postpartum care management activities. However, it is unknown whether expanding care management for infants to address maternal needs would be acceptable. Designing dyad care management based on an understanding of patient and clinician values is critical to facilitate eventual testing and implementation, and to ensure any program innovation is patient-centered, and effective, including cost-effective (Dopp et al., 2019; Lyon & Bruns, 2019). This study was conducted to explore acceptability of dyad care management among birthing people after preterm birth and clinicians who work with this population.

METHODS

Setting, population, and local care management programs

This qualitative study occurred at a pediatric health system and a geographically adjacent health system that provides obstetrical care and adult primary care. Since 2017, the pediatric system has provided care management for children with medical complexity. In this system, care management is typically embedded in primary care, and staffed by registered nurses who create care plans, schedule and plan for well visits and annual influenza vaccine, and follow-up on acute utilization. Care managers also help communicate across clinical divisions, assist clinical teams with documentation for and communication with schools, home care services, and providers of medical equipment, and respond to patient and family needs. In this health system, similar to other systems, children are eligible for care management based on complex chronic conditions and health care utilization (Feudtner et al., 2014; Kuo et al., 2018).

Study inclusion criteria were intended to elicit perspectives of women likely to have substantial health care needs after birth and to capture experiences with pediatric care management. We purposively sampled mothers of preterm Medicaid-insured infants in two phases. We defined preterm as birth at < 34 weeks or 34 – 36 weeks with a known modifiable risk (e.g., tobacco use). First, we sampled from one primary care site chosen for its large population of Medicaid-insured infants and included women within 9 months of birth. Next, we sampled women whose infants participated in care management. Because relatively few families receive care management, we expanded to two additional primary care sites with similar payer mixes and urban locations (3 sites total) and included women within 3 years of birth to meet sample size goals. Eligible participants were identified from pediatric electronic health records.

Clinicians represented a convenience sample. Our study team includes clinicians in Pediatric primary care, Pediatric care management, Neonatology, Obstetrics, and Family Medicine. We collaboratively generated a list of clinicians with experience relevant to dyad care management after preterm birth, focusing on clinicians with leadership positions in primary care and care management, social work, and obstetrics. We added to this list through snowball sampling.

This study was reviewed by the Institutional Review Board at our institution and was considered exempt. We followed COREQ reporting guidelines for qualitative research.

Interview guides

Interview guides were informed by Self-Determination Theory, a health behavior theory, and by literature on health care access and health behavior after pregnancy (Coleman et al., 2009; Patrick & Williams, 2012). For women after preterm birth, we asked about experiences with health care access and priorities after birth. We focused on the early interconception period, which is also emphasized in recent innovations such as Fourth Trimester care and is a period with established care navigation needs (Green et al., 2023). Discussion of care management was refined across interviews. For example, in early interviews we asked for perspectives on hypothetical support either during infant visits or by phone. Later, for interviews with women whose infants participated in care management, we asked whether care managers ever addressed maternal needs. We explored perspectives on care managers taking a formal role in supporting participants’ own health and on privacy, given that care managers often facilitate sharing information on treatment plans, goals, and priorities across health care teams. Participants were asked to complete a demographic survey to contextualize the sample.

The clinician interview guide mirrored the guide for mothers by exploring experiences caring for women after preterm birth, perceived priorities after preterm birth, and perspectives on existing care management programs, and pediatric roles more generally, addressing maternal health. We provided the AHRQ care management definition for participants who were not familiar with local programs. Clinicians were asked to report their department, clinical credential, and time in their profession and current role.

Interviews that occurred after 3/2023 asked whether responses would have differed if interviews were conducted prior to the COVID pandemic.

Recruitment and interviews

Recruitment occurred by telephone for women after preterm birth and by email for clinicians. Some interviews occurred in person. Based on participant preference and the emergence of COVID, most interviews occurred by phone or, for clinicians, by video. Interviews were conducted privately, or with young children of participants present. Participants were offered gift cards to offset the burdens of participating in research.

Interviews were semi-structured, allowing interviewers to add questions to clarify or explore responses. Interviews were conducted by one of five female researchers (including AM, KW, EG). Interviewers had previous qualitative experience in relevant areas including NICU, home visiting, and newborn primary care. Interviewers had no pre-existing relationship with participants. Participants were informed that interviewers were professionally employed as researchers at our institution. All interviewers were oriented to the research project and the theories underlying the interview guides. Interviews continued until we reached thematic saturation in each subgroup (i.e., women after preterm birth, women after preterm birth with care management experience, and clinicians). Interviews were audio-recorded and transcribed by a professional transcription service.

Analysis

We used an integrated approach to coding (Bradley et al., 2007). Using NVivo software (Version 12.0, 2018), we first created an a priori codebook reflecting constructs that informed the interview guide (e.g., health care access and pediatric role in maternal health). We also used an inductive approach to assess content not represented in our a priori assumptions. As we began coding transcripts from each subgroup we coded two transcripts as a team to ensure applicability of codes.

Coders included a subset of interviewers (EG, AM, KW) as well as four students in nursing, public health, and post-baccalaureate programs. All coders had training in qualitative research and were oriented to the project. All transcripts were coded by two people, who met to review differences in coding. Throughout the coding process, all differences in coding were viewed as opportunities to clarify the coding scheme and were resolved through discussion (Barbour, 2001). One coder (EG) coded at least two interviews with each other coder to promote consistency.

During interviewing and coding, the study team held regular debriefing meetings to review impressions and consider coding scheme revisions. After meetings memos were circulated related to changes and clarifications. Meetings and memos were intended to promote reflexivity (i.e., considering the extent to which our own experiences and beliefs influenced coding). Our research team included members from a range of races, ethnicities, relationships to health care, and experiences as parents, which we believed strengthened our interpretation and analysis of data. Transcripts were not returned to participants for comment nor were participants asked to provide feedback on findings because we did not retain participant contact information.

RESULTS

We interviewed 57 participants (Figure 1), including 33 women after preterm birth, 15 of whom had children in care management, and 24 clinicians. Women after preterm birth predominantly reported Black race and had a mean age of 29 years (Table 1). Clinicians included physicians, nurses, and social workers (Table 2). Representative quotes are presented in Table 3. We found no differences in perspectives between women whose infants had participated in care management and those who had not. Indeed, we found convergence on most themes among subgroups, with some exceptions noted. For participants interviewed after 3/2023, most indicated that responses would not have differed prior to COVID, but reported that issues related to postpartum support were particularly salient and acute in the context of COVID.

Figure 1:

Figure 1:

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Identification and recruitment of the sample

Table 1:

Characteristics of sample and interviews of women after preterm birth

Mean (SD), or No. (%) Participants with preterm
infant not receiving care
management
(first phase)

N=17* 		Participants with preterm
infant receiving care
management
(second phase)

N=15
Participant characteristics
Participant age, years 27 (6)
Range: 18 – 41		 31 (6)
Range: 22 – 42
Infant age at interview, months 4 (2)
Range: 2 – 8		 19 (7)
Range: 7 – 34
Gestational age at birth, weeks 31 (4)
Range: 25 – 36		 27 (4)
Range: 22 – 35
Race
Black or African American 17 (100%) 13 (87%)
Other 0 (0%) 2 (13%)
Hispanic ethnicity 0 (0%) 0 (0%)
Educational attainment
High school or less 12 (71%) 9 (60%)
Some college 4 (23%) 4 (27%)
Bachelors or graduate degree 1 (6%) 2 (13%)
Participant relationship with infant’s biological father
Married or live together 9 (52%) 2 (13%)
Don’t live together, parents in a relationship 1 (6%) 4 (27%)
Don’t live together, father involved with child 6 (35%) 6 (40%)
No relationship 1 (6%) 3 (20%)
Interview characteristics
Timing of interviews 10/2018 – 2/2020 12/2020 – 7/2021
Interview length 39 (7)
Range: 25 – 51		 35 (11)
Range: 18 – 55
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*

We interviewed 18 women during the first phase, but one participant declined the demographic survey.

Table 2:

Characteristics of clinician participants

N=24
Participant characteristics
Credential
Physician 14 (58%)
Nurse practitioner 4 (17%)
Registered nurse 2 (8%)
Social worker 4 (17%)
Department
Pediatric primary care 5 (21%)
Pediatric care coordination 4 (17%)
Neonatology 4 (17%)
Obstetrics 7 (29%)
Family Medicine 4 (17%)
Interview characteristics
Timing of interviews 3/2021 – 11/2021
Length of interviews 40 (27 – 52)
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Table 3:

Representative quotes on acceptability themes

Quotes from women with a history of preterm birth Quotes from clinicians
1. Acceptability and appropriateness of pediatric-based dyad approaches
1a. Dyad care management is acceptable and appropriate [Pediatric care managers taking a dyad approach] would make a significant difference in my overall well-being with my son and myself. Because with [the care manager] being in her position… and then have a concern for the mother as well… Because if the mom is okay, and she's doing well, then the baby should be doing well. I don't necessarily have the bandwidth to [address care navigation]. So if somebody else, this is like part of their job and part of their role, I think would be incredible, not only for the patients, but also for the physicians and care teams… to know like your patient has somebody that's there that's going to help them.
1b. Infant needs may overwhelm maternal needs I kinda blacked [my appointments] out and only thought about baby. I wasn’t purposely missing it, but I was so focused on her… sometimes when I feel like I am thinking about myself, I feel guilty… I didn’t realize how important it is to take of myself until people actually asked me, and I’m like, oh, well maybe I should think about it.” Sometimes what happens is they're so focused on getting the baby to health care, which is very important. But sometimes they put their health care aside for a while. Clin05
1c. Infant and maternal wellbeing are interconnected My priority is always going to be my children so, me, making sure that I’m okay is true, because if I’m not okay then the kids not going to be okay. If the parent's not doing well in any way, from a social economic perspective, a mental health perspective or a physiologic health perspective, it's going to impact the care of the child… It's got to be connected.
2. Acceptable care management content and family priorities after preterm birth
2a. Traditional interconception health behaviors [After pregnancy] you try to change and be more healthier. Just like a lot of negative things that I’ve been staying away from, but more so now. Bad things like smoking, drinking, food that’s not so good for you. If somebody [had talked with me], after I had my children, about exercising and eating well I probably would’ve smacked them. I just can’t bring that up with a mother. Clin02
2b. Stress management and sleep I want to do that breathing exercises because it keeps me calm. Because you know, when the baby is crying and things like that you know, a lot of things run across your head. And you just want to make sure that you're always calm and patient and then me catching up on some sleep. I think mental health, sleep hygiene, I mean like taking care of themselves. I feel like that’s definitely obviously, one of the biggest issues. They don't take care of themselves; they just get worse…. If you’re not sleeping, you can’t be there for your baby.
2c. Economic and physical security My priorities was kind of getting back to work because unfortunately I had a job that wasn’t paying for maternity leave, so that and making sure my child had childcare and making sure his health was healthy. Having a preterm baby is a big, much bigger stressor for a parent…. So, I think making sure that that family is, and the mother is particularly safe, still living in a safe housing environment, in a safe relationship. Making sure that she has some supports.
3. Acceptability of care management team members
3a. Shared experiences I would want someone who comes from a background of either working, living, experiencing, having some type of ties to the urban community. Because a lot of times, I feel like with people of color especially, and especially coming from these urban areas, we don’t really have people in those positions that can really relate to where we come from… [and] I would definitely want them to have a background in the medical field. It would be so helpful to have somebody who patients can identify as like oh yes, like this is a member of my community who's helping me get connected to these community resources and they are going to have my back and they're not just some random like third party person that was like plucked from the sky who knows nothing about me or where I live.
3b. Interpersonal skills Somebody that know how to draw it out of you without drawing it out of you. How people just got that personality that just makes you talk to them. Somebody who’s good at getting families bought in. Like, there are just some people who when they talk with families, the families want to engage with them and they want to kind of do what they’re being asked to do because that person has that like special it factor of like making everyone wanna be part of the team.
3c. De-emphasize specific credential If they have medical experience that would be a plus, but that I don’t think would kind of make or break my decision [to work with them]. A nurse navigator would be more expensive, a social worker would be less so, a community health worker maybe would be less so.… I’m thinking sometimes it depends on your budget.
3d. Perspectives on social work It all depends on your experience with the social work, if you had a negative experience with them that might deter some people away from just that title. But if not, then I don’t think it would be an issue. A lot of times when people think of hospital, baby, social worker, it’s not a good trio. So, they sometimes think [social workers] may be coming in to talk about Child Protective Services, and very rarely is that the case.
4. Flexibility
4a. Needs change over time It’d be up to the person, instead of having a time scheduled because you never know what they’re going through in between time. Especially with first-time moms I don’t even think you’re about to sort of like grasp what your needs are initially in the first like three days.
4b. Needs and supports vary across individuals [Care management wouldn’t have helped me] not so much. I had a lot of help from my family. We’re not just saying, “Oh, you had a preterm birth, so here’s what you’re going to need.” But I think… trying to take like each individual case separately and trying to assess what’s happening in that person’s life and what potentially could be helpful. Because one size isn’t going to fit all.
4c. Privacy and information sharing across teams I would be well with [a care manager] communicating with [my doctors]… [But] there may be some things [I don’t want shared] maybe, yeah… If it was like a depression issue, I wouldn’t - I don’t think I would want the whole team to know.
In some areas I might feel okay. Especially if we’re talking about mental health or depression, things like that. I wouldn’t mind [my baby’s care manager] talking to my doctor about something like that… [But] if I’m having trouble with bills, or trying to find resources to help me financially, I wouldn’t want the doctors to know about that.
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Acceptability and appropriateness of dyad care management

All participant subgroups agreed that pediatric-based dyad care management is acceptable and appropriate after preterm birth (Table 3, Section 1). Women after preterm birth thought that providing care management services would demonstrate caring by health care teams. They also articulated two rationales for locating services in the pediatric setting. First, they noted that infant needs had often overwhelmed their own needs in the period after birth. As one woman said, “I wasn’t purposely missing [my appointments], but I was so focused on [my baby].” Second, women noted that parenting infants motivated them to care for themselves.

Clinicians also found dyad care management after preterm birth acceptable, noting that they would consider care management services acceptable and appropriate for a range of families in their practices. Clinicians thought care management could also benefit clinicians, who may be aware of some needs that they lack time or skills to address. As one clinician said, “It would be incredible… to know your patient has somebody… that’s going to help them.” Clinician themes on providing dyad services in pediatrics converged with those of women after preterm birth. Clinicians noted that parents tend to prioritize infant needs, and that meeting infant needs depends on parental wellbeing. However, some clinicians were hesitant to endorse pediatric-based services for parents. These clinicians suggested that care managers addressing adult needs should be embedded in adult care teams to ensure appropriate supervision.

Acceptable care management content and family priorities after preterm birth

Women after preterm birth endorsed the importance of traditional interconception health topics (e.g., diet, tobacco avoidance) (Table 3, Section 2). They also emphasized behavioral health and adequate sleep. Behavioral health was sometimes described using language related to stress management, though more formal terms such as depression and anxiety were used as well. For example, one woman said, “I want to do that breathing exercises because it keeps me calm.”

Women also prioritized returning to work or school, with comments like “unfortunately I had a job that wasn’t paying for maternity leave,” safe and stable housing, and childcare. Women whose infants had medical complexity included adequate training on infant needs and access to medical equipment in their goals for a safe home environment.

Clinicians were uncertain that diet or exercise were priorities after preterm birth. However, clinician themes converged with women in emphasizing sleep, behavioral health, and economic and physical wellbeing as priorities. As one clinician said, “Making sure the family is… still living in a safe housing environment, in a safe relationship.”

Acceptability of care management team members

Women after preterm birth wanted to work with care managers who shared their experiences and had strong interpersonal skills (Table 3, Section 3). For some, shared experience focused on their experience having a pre-term birth while others focused on aspects of their personal or community identity. One woman suggested hiring someone for a dyad care management role who has “that personality that just makes you want to talk to them.” They preferred care managers with some health care background but considered a range of credentials appropriate. Social workers, nurses, and community health workers were all mentioned spontaneously. Women noted that some people may be unwilling to work with social workers because of prior negative experiences.

Clinician themes converged with those of women after preterm birth in valuing personal experience and strong interpersonal skills over a specific credential. One clinician suggested care managers should be, “somebody who patients can identify as like oh yes, this is a member of my community.” In addition to social workers, nurses, and community health workers, clinicians mentioned doulas for this role. Clinicians also noted that social workers in pediatric settings may be equated with child protective services, possibly threatening acceptability.

Clinicians with experience in care management emphasized matching the credential to the intended services to maximize funds and ensure appropriate supervision. Clinicians in Obstetrics and Neonatology emphasized the need for perinatal health expertise most consistently.

Flexibility

All participants emphasized that care management acceptability would be enhanced by ensuring programmatic flexibility (Table 3, Section 4). Women after preterm birth noted that needs change over time in unanticipated ways. Some women noted that support from other sources, typically family, would have made them uninterested in care management for themselves. For example, one participant noted she wouldn’t have needed care management, saying, “I had a lot of help from my family.” Women therefore recommended allowing individual needs to drive service content and intensity. Some noted that, without this flexibility, care management could become burdensome to families.

Women were open to meeting with care managers by telephone, video, or in-person. Some women preferred telephone contact as providing flexibility without the technology problems they associated with video. Among those who commented on preferred frequency of contact, most suggested every 2 – 4 weeks.

Care management programs may facilitate sharing information about treatment plans and health-related goals or barriers to health across health care teams. Women after preterm birth described positive, negative, and ambivalent perspectives on care managers sharing information. There were also differing opinions on which topics would be most sensitive though most agreed that, as one participant said, “in some areas I might feel okay” with teams sharing information.

Similar to women after preterm birth, clinicians noted that needs change unpredictably over time, with one noting, “I don’t think you’re able to sort of like grasp what your needs are initially.” Clinicians also noted that preterm birth does not automatically confer a discrete set of health care needs and emphasized the importance of considering individual needs and goals to enhance acceptability.

CONCLUSIONS FOR PRACTICE

Pediatric-based dyad care management was considered an acceptable strategy to promote health care access and wellbeing for women after preterm birth by both potential program users and clinicians. Acceptability of dyad care management programs could be enhanced by creating flexible programs and addressing common priorities such as stress management and sleep. These content areas contrast with prior pediatric-based programs addressing interconception health, which have primarily emphasized topics such as contraception, vitamins, tobacco use, or clinically significant symptoms of depression (Srinivasan et al., 2018; Upadhya et al., 2020).

Participants agreed that characteristics of care managers could also promote acceptability. They recommended that care managers have strong interpersonal skills and share life experience with program users. Community health workers may therefore be a good fit for dyad care management, because they are often identified based on these characteristics (Brown et al., 2020). However, participants also thought that perinatal health expertise would be warranted in this role. This perspective was strongest among certain clinicians but was present across subgroups. Specific health knowledge is not a universal feature of community health worker programs but is consistent with some perinatal community health workers programs and with maternal-child home visiting programs (Cunningham et al., 2020; Olds, 2006). Participants’ openness to multiple credentials in this role suggests that selecting staff based on local feasibility would not compromise acceptability.

Though care management was considered acceptable, women after preterm birth had mixed perspectives on health care teams sharing their personal information. Health systems often promote information sharing, enabled by clinical roles such as care management that support communication between teams, and by health information exchanges and related technologies. In prior work, patients were most supportive of data sharing technologies in settings with high perceived benefits to data sharing, high overall clinical quality, or when consent and sharing procedures were transparent (Esmaeilzadeh & Sambasivan, 2017; Shen et al., 2019). We are unaware of other studies that examine perspectives on sharing information between clinical teams caring for different family members to facilitate care. Our findings suggest dyad care management programs should maintain transparency by seeking consent for data sharing and should accommodate varying preferences.

We focused on parents with heightened risk of future adverse pregnancy outcomes, who represent only a subset of parents who might benefit from dyad approaches (Hagerman et al., 2022; Shah et al., 2021). Indeed, clinicians in our study recognized a broader need for dyad care management. Trends demonstrating increased health care needs in childhood will, over time, translate into increased chronic disease in pregnancy, and ultimately increased disease burden among parents (Admon et al., 2017; Wise, 2007). Health systems and payers may see growing benefits to adopting dyad, or family-oriented, health promotion strategies.

The women we interviewed all had a history of preterm birth and most identified as Black race. Though our findings may not be generalizable to all parents, identifying acceptable interventions for women similar to those in our sample is important to addressing racial inequities in birth outcomes and long-term health.

This analysis had several limitations. In addition to focusing on a particular population of parents, it was conducted at two geographically adjacent health systems. This may limit generalizability, particularly to non-urban locations, non-English speakers, or settings serving populations of women with different characteristics. In addition, we sampled women through pediatric health settings, and may not have captured perspectives of women whose families are less engaged in care. Third, we were unable to confirm whether participants’ reported preferences would be consistent with their actual uptake of care management services or identify a specific time-period that services might be more used. Recent work on postpartum care navigation suggests the highest needs are within 2 – 4 months of birth (Green et al., 2023). Finally, this analysis does not discuss barriers to dyad care management or other aspects of feasibility. Content related to feasibility was generated by these interviews, primarily during interviews with clinicians. Analysis of that content is described in a separate manuscript.

In conclusion, dyad care management is viewed as an acceptable intervention to support health care access and wellbeing of women after preterm birth. Acceptability was supported by the perceived flexibility of the intervention to tailor services for participants whose needs may differ or change over time. Understanding factors that promote intervention acceptability is important to designing interventions that may be broadly implemented. Our findings support testing dyad approaches after preterm birth to improve women’s experience with interconception health care, promote interconception health, reduce recurrent birth complications, and support long-term health.

Funding:

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (K23HD102560). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Conflict of Interest Statement: None declared

Ethics approval: This study was reviewed by the Institutional Review Board at the Children’s Hospital of Philadelphia and was considered exempt.

Consent to participate: Verbal informed consent was obtained from all participants using a consent form consistent with our institution’s guidelines for informed consent.

Availability of data and material: Access to de-identified data is available upon request to the authors.

Code availability: Coded data is available upon request to the authors.

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