{"doi":"10.1111/jrh.70056","title":"Use of telehealth did not mitigate persistent disparities in prenatal care access among American Indian women in North Dakota","abstract":"BACKGROUND: In North Dakota (ND), American Indian (AI) women face a persistent disparity in prenatal care (PNC) access compared to other women. During the COVID pandemic, the expansion of telehealth emerged as a potential solution to disparate access to health care. We examined whether telehealth use mitigated disparities in PNC in ND. METHODS: Data were drawn from the 2020 to 2021 ND Pregnancy Risk Assessment Monitoring System (weighted n = 10,189). PNC initiation >13 weeks gestation or not receiving PNC was considered \"late/no PNC.\" Maternal race/ethnicity was self-reported. Use of telehealth for prenatal visits was self-reported and categorized as \"any telehealth use\" versus \"no telehealth use.\" Those not using telehealth self-reported eight barriers to telehealth (e.g., lacking internet, no appointments). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for late/no PNC among AI and other race/ethnicity women compared to White women. Models included maternal sociodemographic and health factors. Chi-square was used to examine prevalence of telehealth barriers by race/ethnicity. RESULTS: Compared to White women, AI/AN women were twice as likely to receive late/no PNC (OR: 2.40; 95% CI, 1.08, 5.35). When telehealth was accounted for, the AI-White disparity was lowered by only 2% (OR: 2.35; 95% CI, 1.05, 5.26). Compared to White and other race/ethnicity women, a higher prevalence of AI/AN women reported a lack of telehealth appointments (p < 0.01), no computers (p < 0.01), no phones (p < 0.01), and no physical space (p < 0.01) as barriers to telehealth. DISCUSSION: The use of telehealth did not mitigate PNC disparities in ND. Infrastructure investments and culturally safe initiatives are needed to improve PNC access for AI/AN women.","journal":"The Journal of Rural Health","year":2025,"id":545475,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8723,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1387117,"name":"Anna Charlotta Kihlstrom","orcid":null,"position":1,"is_corresponding":false},{"id":1386673,"name":"Nishat Sultana","orcid":"0000-0001-6896-6504","position":2,"is_corresponding":false},{"id":1317581,"name":"Grace Njau","orcid":null,"position":3,"is_corresponding":false},{"id":1386674,"name":"Matthew Schmidt","orcid":"0009-0003-8740-5333","position":4,"is_corresponding":false},{"id":1387119,"name":"Anastasia Stepanov","orcid":null,"position":5,"is_corresponding":false},{"id":545885,"name":"Andrew Williams","orcid":"0000-0002-0411-3171","position":6,"is_corresponding":false},{"id":1387118,"name":"Tara Stiller","orcid":null,"position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T02:53:23.001995Z","pmid":"40692185","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}