Table 5 Initial Prototypes, participant scoring and feedback, conclusions and rationale

SUPPORT SISTER

Person on your care team who has gone through this experience, and is there to guide, support and get you what you need throughout your pregnancy and after.

Design Opportunity 1(a), 3(a) 6(a), 7(a)

Adopted for implementation

Summary: Many comments revealing high enthusiasm for this concept

Refinement: Questions emerged around if Support Sisters should be hired within health systems or be community based, recognizing that within health system allows for important integration with health system, but may compromise ability of support sister to effectively advocate for client if in conflict with health system staff.

Rationale and final prototype details:

• High impact for providing support, helping navigate resources, and identifying/mitigating interpersonal racism

• Prototype to specifically focus on how community-based Support Sisters can be sustainably integrated into healthcare teams to allow for care that is more comprehensive (provides practical, emotional, and social support), is well-coordinated (insight and outside of healthcare system), and provides cultural sensitivity and lived experience.

COMMUNITY CENTER FOR PREGNANCY AND YOUNG FAMILIES

A community center as a “one-stop-shop” that provides clinical and non-clinical services, and support for pregnant people and young families

Design Opportunity 2(a), 4(a), 5(a), 7(a)

Adopted for implementation with refinement

Summary: Many comments revealing high enthusiasm for this concept

Refinement: Comments revealed that people thought this would be most helpful if within one’s own neighborhood. Broad array of services and goods desired.

Rationale and final prototype details:

• High impact for reducing barriers to care, tackling systemic and institutional racism, shifting power dynamics, and investing in community support.

• Recognizing that this could not exist in every neighborhood, this prototype was combined with “Services that come to you” and “Build community with your care team” prototypes (below) to create the “Pregnancy Village” prototype, as described in results section. Pregnancy Village brings services and goods into neighborhoods making them easier to access, while also providing an environment to foster community support, shift problematic power dynamics with providers, and develop more trusting partnerships between pregnant people and service providers.

SERVICES THAT COME TO YOU

A mobile unit that travels to your neighborhood with helpful services and offerings.

Design Opportunity 2(a), 5(a)

Adopted for implementation with refinement

Summary: High enthusiasm for services being brought to one’s own neighborhood

Concerns were around how to make this look and feel respectful—i.e. would people be lining up waiting for services? How would the mobile unit look and feel inside – “cold and clinical” versus “warm and comfortable”?

Rationale and final prototype details:

• Combined with Community Center prototype (see above) to create “Pregnancy Village” prototype, as described in the results section of manuscript.

• Mobile unit a necessary part of Pregnancy Village prototype to deliver more private (clinical) services

PRENATAL CARE FROM HOME

Video chat with your pregnancy care team from home, instead of coming into clinic.

Design Opportunity 5(a)

Adopted for implementation

Summary: Feedback was mixed, with some participants enthusiastic about the convenience of this option and others not sure it would be personal enough.

Refinement: Must be implemented in an equitable way to ensure access and value for those with low resources and varying levels of digital access and literacy.

Rationale and final prototype details:

• Low-effort, high-impact intervention for pregnant persons who would want this option (and would not negatively impact those who wouldn’t).

• Should be implemented as an option across the safety-net system so is an option, when clinically appropriate, for any pregnant person who would like it. Should not be required just because eligible.

USEFUL TRANSPORTATION

Provide transportation options that offer pregnant person education and will check you in to clinic on the ride.

Design Opportunity 5(a)

Not adopted for implementation

Summary: High average score but not many comments, revealing low enthusiasm.

Rationale: Given pregnant persons get care from multiple different clinics, this would be a high-effort intervention with unclear impact. Additionally, based on enthusiasm for bringing clinical services into neighborhoods, decided to prioritize “Pregnancy Village” model over this prototype.

BUILDING COMMUNITY WITH YOUR CARE TEAM

Activities that allow you to get to know your doctors and midwives in a setting outside the clinic, to build trust and relationships.

Design Opportunity 1(a), 1(b), 2(a) 7(a)

Not adopted for implementation

Summary: Some enthusiasm, but comments revealed that other mechanisms such as continuity of care and longer appointments were most important factors in building trust and relationships.

Rationale: Included this prototype/concept into the “Pregnancy Village” prototype as described in the results section.

CHOOSE FEWER VISITS

Reduce minimum number of doctor or midwife visits to five and have other visits with whoever you choose from care team (for example, support sister or a healthcare educator)

Design Opportunity 6(a) 7(a)

Not adopted for implementation

Summary: Poor enthusiasm for this concept, with many people concerned about the safety of having so few visits with providers, and wondering how they would know when they need to see a provider

Rationale: While studies show five clinical visits safe for low-risk pregnant people, pregnant persons are not comfortable with this approach.

LEARN THROUGH EXPERIENCE

Learn about pregnancy-related topics through the eyes of a peer who has experienced it using virtual reality technology.

Design Opportunity 7(a)

Not adopted for implementation

Summary: Poor enthusiasm for this concept, though did think might be a helpful adjunct to different classes/ education that are already available (lactation, labor & delivery, birthing)

Rationale: Low impact