Identifying Patient Benefits of a Novel Tool in Routine Prenatal Care: An Exploratory Factor Analysis Approach

Rivelli Anne^{1, 2,} , Fitzpatrick Veronica^{1, 2}, Shields Maureen^{1, 2} and Erwin Kim³

¹Advocate Aurora Research Institute, Downers Grove, IL, United States of America

²Advocate Aurora Health, Downers Grove, IL, United States of America

³Illinois Institute of Technology, Institute of Design, Chicago, IL, United States of America

Cite this paper:
Rivelli Anne, Fitzpatrick Veronica, Shields Maureen and Erwin Kim. Identifying Patient Benefits of a Novel Tool in Routine Prenatal Care: An Exploratory Factor Analysis Approach. American Journal of Applied Mathematics and Statistics. 2023; 11(1):22-29. doi: 10.12691/ajams-11-1-4

Abstract

To address the need for cost-of-care conversations in prenatal care, the CONTINUE (cost conversations in routine prenatal care) study was conducted with prenatal patients to better understand the benefits of implementing a cost-of-care conversation “cost” tool into routine obstetrics (OB) care. This research team conducted a multi-phase, mixed-methods research study to identify 18 target benefits of a cost tool to initiate and standardize cost-of-care conversation and, subsequently, developed and validated a cost tool. The novel cost tool was piloted and data pertaining to target benefits were collected through interviews and surveys. To assess the cost tool’s utility, data from interviews and surveys were unified and exploratory factor analysis was performed to classify the underlying factor structure of the 18 benefit item responses. Data includes patients’ self-reported ratings of benefit items, as collected from third trimester prenatal patient participants who received the tool at the beginning of their prenatal care in three midwestern-based hospital clinics within one healthcare system. The present study details the factor analysis approach used to identify the three final factors that emerged from the data representing prenatal patients benefits of utilizing a cost tool. This analysis provides a framework for exploring patient-specific predictors of experiencing identified benefits (i.e. factors) of a novel cost tool incorporated into routine OB care.

Keywords:
prenatal care pregnancy females factor analysis statistical delivery of health care

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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References:

[1]	Kaiser Family Foundation. Women’s Coverage, Access, and Affordability: Key Findings from the 2017 Kaiser Women’s Health Survey. kff.org. Published March 13, 2018. Accessed May 3, 2022. https://www.kff.org/womens-health-policy/issue-brief/womens-coverage-access-and-affordability-key-findings-from-the-2017-kaiser-womens-health-survey/.
[2]	Meluch AL, Oglesby WH. Physician–patient communication regarding patients' healthcare costs in the US: a systematic review of the literature. J Commun Healthc. 2015; 8: 151-60.
[3]	Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004; 164: 1749-55.
[4]	Rising S. Centering Pregnancy: An interdisciplinary model of empowerment. J Nurse Midwifery. 1998; 43: 46-54.
[5]	Novick G. Women’s experience of prenatal care: an integrative review. J Midwifery Women’s Heal. 2009; 54(3): 226-237.
[6]	Ngo E, Truong MBT, Nordeng H. Use of decision support tools to empower pregnant women: systematic review. J Med Internet Res. 2020; 22(9).
[7]	Erwin K, Fitzpatrick V, Norell S, Gilliam M. Development of a framework and tool to facilitative cost-of-care conversations with patients during prenatal care. Annals of Internal Medicine. 2019; 170: 562-569.
[8]	Chen E, Neta G, Roberts MC. Complementary approaches to problem solving in healthcare and public health: Implementation science and human-centered design. TBM. 2021; 11: 1115-1121.
[9]	Child D. (1990). The essentials of factor analysis, second edition. London: Cassel Educational Limited.
[10]	Costello AB, Osborne J. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research and Evaluation. 2005; 10(7): 1-9.
[11]	O’Rourke N, Hatcher L. A Step-by Step Approach to Using SAS for Factor Analysis and Structural Equation Modeling, Second Edition. Accessed May 5, 2022. https://www.sas.com/storefront/aux/en/spsxsfactor/61314_excerpt.pdf.
[12]	Korstanje J. What is the difference between PCA and Factor Analysis? Published December 7, 2020. Accessed May 6, 2022. https://towardsdatascience.com/what-is-the-difference-between-pca-and-factor-analysis-5362ef6fa6f9.
[13]	Beavers AS, Lounsbury JW, Richards JK, Huck SW, Skolits GJ, Esquivel SL. Practical considerations for using exploratory factor analysis in educational research. Pract Assess, Res Evaluation. 2013 Mar; 16(6): 1-13.
[14]	Factor Analysis. Stats.oarc.ucla.edu. Accessed May 6, 2022. https://stats.oarc.ucla.edu/sas/output/factor-analysis/.
[15]	Tabachnick, BG & Fidell LS. (2007). Using Multivariate Statistics (5th ed.). New York: Allyn and Bacon.
[16]	The Factor Procedure. Accessed May 1, 2022. https://support.sas.com/documentation/onlinedoc/stat/141/factor.pdf.
[17]	Castro-Schilo L. Principal Components or Factor Analysis? Towardsdatascience.com. Published May 7, 2021. Accessed May 8, 2022. https://towardsdatascience.com/principal-components-or-factor-analysis-fcc98225b932#:~:text=PCA%20and%20EFA%20have%20different,%2C%20latent%20variables%20or%20factors.
[18]	Suhr DD. Exploratory or confirmatory factor analysis? Accessed May 5, 2022. https://support.sas.com/resources/papers/proceedings/proceedings/sugi31/200-31.pdf.
[19]	Goldberg RJ. PROC FACTOR: How to Interpret the Output of a Real-World Example. Accessed May 8, 2022. https://support.sas.com/resources/papers/proceedings/proceedings/sugi22/STATS/PAPER268.PDF.
[20]	Rivelli A, Fitzpatrick V, Shields M, Erwin K, Delfinado L, Cabiya M, Wennerberg K. The benefits of introducing a pregnancy support tool for low-income women in routine obstetrics care. J Prim Care Community Health, 2023 [in press].
[21]	Fitzpatrick V, Erwin K, Rivelli A, Shields M, Delfinado L, Cabiya M, Wennerberg K. The impact of introducing a cost tool to facilitate cost-of-care conversations in routine OB care: Lessons from the CONTINUE study. PEC Innovation, 2023 [in press].
[22]	De Winter JCF, Dodou D, Wieringa PA. Exploratory factor analysis with small sample sizes. Multivariate Behavioral Research. 2009; 44: 147-181.