Beyond Intentionality: A Latent Class Analysis of Barriers to Prenatal Care in an Explanatory Mixed Methods Study

Objective: Utilizing the Health Care Access Barriers (HCAB) Theoretical Framework, this study examines latent profiles of barriers to prenatal care among pregnant women in Alabama and whether these profiles mediate or moderate the relationship between pregnancy intentionality and early prenatal care initiation. Methods: An explanatory mixed-method design was employed, integrating quantitative analysis of Alabama Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 data (2016–2021) with qualitative insights from expert interviews. Latent class analysis (LCA) was performed to identify subgroups based on prenatal care barriers. Logistic regression models evaluated the association between pregnancy intentionality and early prenatal care initiation, controlling for demographic covariates. A Firth-penalized multivariable logistic regression model evaluated interaction effects. Results: Planned pregnancy was associated with higher odds of early prenatal care initiation (OR = 0.78, 95% CI [0.49, 1.23], p = .286), though this relationship did not reach statistical significance. Barrier profiles neither moderated nor mediated this association, and the interaction term remained non-significant (OR = 5.19, 95% CI [0.22, 828.94], p = .309). Mediation analysis also showed no significant indirect effect through latent class membership (indirect effect = 0.012, p = .518). Expert interviews highlighted persistent systemic and cognitive barriers to early prenatal care access, reinforcing the need for targeted interventions. Conclusion: While pregnancy intentionality was not a statistically significant predictor of early prenatal care initiation, expert insights highlight persistent systemic and cognitive barriers that contribute to delays in access. These findings underscore the need for multi-level strategies to address informational and logistical challenges in prenatal care. Future research should examine additional pathways that influence care-seeking behaviors.