Development and Evaluation of a Conceptual Framework for the Use of Fetal Myelomeningocele Repair.

Objective: To develop and evaluate a conceptual framework of the use of fetal myelomeningocele/myeloschisis (fMMC) repair.

Design: Exploratory sequential mixed methods study.

Setting: Midwest Fetal Care Center, Minneapolis, Minnesota.

Participants: Fetal care experts (n = 7) and health records of patients evaluated for fMMC repair (n = 159).

Methods: Through an expert roundtable, we developed a conceptual framework for the use of fMMC repair based on Andersen's behavioral model of health service use (qualitative). We selected variables from our conceptual framework that were available in existing health records to examine associations between contextual and individual factors and eligibility for and use of fMMC repair (quantitative).

Results: Our conceptual framework (qualitative) included predisposing contextual factors (prenatal health care, community norms), enabling contextual factors (health care/insurance policies, referral patterns, center attributes), predisposing individual factors (demographics, beliefs), and enabling individual factors (finances, eligibility). In the quantitative analysis, we found that very few factors were associated with eligibility or use of fMMC repair, with the exception of private health insurance (p = .01), although we did not measure several contextual factors. Most participants (n = 148, 93%) resided in very low/low maternal vulnerability counties, and we observed no differences between the surgical disposition groups (p = .15).

Conclusions: We developed a framework to identify and conceptually relate contextual and individual-level characteristics that may affect the use of fMMC repair. Our conceptual framework may be used by future researchers to fully evaluate the access to and use of fMMC repair.