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Table 1 Domains and intervention approaches from stakeholder feedback

From: Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community

Domains discussed

Exemplar quotes

mHealth implementation

Language and Communication

"[Patients] want to speak Spanish when they feel vulnerable."

"Find ways to reduce small language barriers, such as hospital menus, [pregnant individuals] have no information on when to order food, etc.—small barriers that exist because of lack of information, caused by lack of language."

Apps in the patient’s native language

Access to and information on translation services

Share information in the patient’s native language on what is going to happen during care and delivery

 

Financial Concerns

"It is common for [pregnant individuals] to have to deal with payment problems because most do not have insurance. [We] have to teach them to understand their body signals so that they go to the emergency room when they are about to give birth. At that time, they could apply for emergency insurance."

"The issue of payment creates stress, that they need to communicate [in English] with the hospital social worker."

Provide information on navigating health-related financial considerations in the U.S

Provide access to information on Federally Qualified Health Centers

Offer postpartum services that are accessible without cost

 

Social Support

"Women with low education and socioeconomic status. Commonly, they do not have anyone who supports them. For example, their mothers had no resources or could not come due to immigration permits."

"They have to limit themselves to a very small circle; they do not have the aunt, the grandmother, the neighbor, in general, the extended network that generally supports Latino women during pregnancy – [they feel that] nothing is not going to happen to me because there are individuals who will take care of me."

Community support through forums connecting Spanish-speaking pregnant individuals

Support programs for doula services that are fluent in the patient’s native language

 

Immigration Status

“Migration problems – they are scared of even leaving the house.”

“[Pregnant individuals] are worried about telling [healthcare facilities] information and that they may contact their place of employment which could jeopardize their jobs.”

Access to information on how immigration status will influence (or not influence) their access to care

 

Cultural Differences

“Pregnancy is traditionally more social and managed among the family.”

“Less-educated women may be focused on using [traditional tea] and other things, natural care, generally this is not communicated to the providers.”

Acknowledge the importance of family as a source of support and provide ways to enhance links to a community of other Latino individuals

Provide information on traditional medicine and how to discuss this topic with providers

Offer nutritional advice based on staples of Latino diets

 

Healthcare Navigation

“In Latin America, healthcare is not a product – it is a public service, and the relationship is totally different. They don’t see themselves as customers in the healthcare system.”

“Mothers must be helped to have the confidence to communicate their problems with nurses, doctors, police (in cases of domestic abuse) – Give them the confidence to communicate with resources themselves.”

Educate providers on the different doctor-patient relationships in Latino cultures

Educate users about their ability to ask questions and participate in their own healthcare decisions

 

Location of Services

“Women will travel if you offer a valuable service… you need to gain trust, once trust is gained you need to give them the tools to overcome a barrier (for example transportation), and then they are highly motivated to go to prenatal classes where they get support.”

“There is a limited number of organizations offering classes and information, especially in Spanish and in a culturally sensitive way, but the main problem is insurance.”

Offer spaces for community organizations to offer classes, collaborate, and form a network to support Latino pregnant individuals