The Association between Technology Capacity and Prenatal Care during COVID‐19 Pandemic: The Modifying Role of Social Support

RESEARCH OBJECTIVE: The Centers for Disease Control and Prevention called for telehealth uptakes to avoid disruption of routine prenatal care (PNC) during the COVID‐19 pandemic. Yet, lack of technology capacity may hinder telehealth access and disrupt PNC. Social support could serve as a protective factor against technology barriers and moderate the association between technology capacity and attending PNC. To date, little data are available regarding the associations between technology capacity, social support, and PNC. This study assessed the associations of technology capacity with PNC provider continuity and overall PNC experience and to examine whether social support modifies such associations. STUDY DESIGN: A nationwide survey was completed from 5/4/2020–5/6/2020 by 668 U.S. pregnant women, 18–44 years of age and being at least 8‐week gestation. Two aspects of PNC were studies: 1) pregnant women's overall rating of PNC experience, ranging from very poor (1) to outstanding (5), and 2) PNC provider continuity, defined as whether a woman stayed with the same PNC provider during the pandemic. Technology capacity was measured as the total scores of participants' confidence and necessary skills for telehealth use (range: 2–10). Social support was assessed using the modified Medical Outcomes Study Social Support Survey and categorized to three levels (low, medium and high) with mean +/− one standard deviation. Multivariable linear regressions and logistic regression were used to examine the associations between technology capacity and PNC outcomes and the modifying roles of social support. POPULATION STUDIED: 668 women who were > 8 weeks pregnant, aged 18–44 years, living and planning to give birth in the United States, and having initiated PNC were included in the analysis. PRINCIPAL FINDINGS: A total of 668 pregnant women have initiated PNC by 5/6/2020. They were mostly aged 25–34 years (91.8%), diverse (44.3% non‐Hispanic Black, 8.5% Hispanic, 44.3% non‐Hispanic White and 6.6% other non‐Hispanic race), urban residents (86.4%), and full‐time employed (63.9%). Technology capacity and social support were positively associated with PNC experience and provider continuity (Ps < 0.01). However, technology capacity was positively related to PNC experience (β = 0.31, 95% CI 0.16 to 0.45; P < 0.001) and PNC provider continuity (OR = 1.80, 95% CI 1.52 to 2.14; P < 0.001) only among women with low social support, but not among women with high social support. CONCLUSIONS: Technology capacity had positive associations with overall rating of PNC experience and provider continuity. These relationships were stronger among women with lower social support. IMPLICATIONS FOR POLICY OR PRACTICE: There is a need to improve technology capacity and/or promote and incentivize social support structures for pregnant women, especially those who lack technology capacity and social support. Clinical healthcare providers may consider providing technology support in the meantime of deploying telehealth resources, in collaboration with communities that can reach out to pregnant women in need. Policymakers and insurers should develop complementary policies to ensure both the supply and demand sides benefit from wide‐spread telehealth use for prenatal care. PRIMARY FUNDING SOURCE: University of South Carolina vice president for research.