Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola Hawley


Objectives: Women of reproductive age in American Samoa have a high-risk for pregnancy complications, due to their high levels of overweight and obesity. Prenatal care can mitigate this risk; however, many women do not seek care. The low rate of prenatal care utilization may stem from a low-level of prenatal care satisfaction. By understanding the predictors of prenatal care satisfaction in America Samoa, targets for improvement may be identified, with the ultimate goal of increasing prenatal care utilization.

Methods: A cross-sectional survey was distributed to women (n=174) in the waiting areas of the clinic at the Lyndon B Johnson Tropical Medical Center, Pago Pago. Women were asked about their demographic background, pregnancy traits, and their satisfaction with prenatal care. Complete satisfaction data was obtained for 165 participants. Different components of satisfaction were extracted using principal components analysis. Linear regression was used to examine associations between maternal characteristics and satisfaction score within these individual components and overall.

Results: The satisfaction questionnaire yielded three components: satisfaction with Clinic Services, Accessibility, and Physician Interactions. Waiting two hours or more to see the doctor was a significant predictor of less satisfaction with Clinic Services, Accessibility, and Overall satisfaction compared to waiting less than 30 minutes. Living more than 20 minutes away from the clinic was associated with less satisfaction with Accessibility, Physician Interactions, and Overall, whereas non-residence was associated with greater satisfaction with Accessibility. Women who were employed or on maternity leave were less satisfied with Physician Interactions than women who were unemployed or students. Of women who had previously been pregnant, a previous pregnancy loss was associated with less satisfaction with Physician Interactions compared to women who had not experienced a pregnancy loss. Women who did not attend all of their appointments were less satisfied with their care overall compared to women who did.

Conclusions for Practice: Prenatal care satisfaction is an important determinant of prenatal care utilization. By identifying specific characteristics that predicted lower satisfaction, we are able to guide providers and health services towards improved prenatal care delivery. Prenatal care clinics should focus on making it easier for women to get to the clinics, decreasing waiting times, and increasing quality face time with providers.

Open Access

This Article is Open Access