A qualitative journey mapping study of prenatal care experiences among rural pregnant women in Northeast China.

Background: The participation rate of prenatal healthcare in China has increased slowly, and the imbalances and inadequacies in the development of maternal and child health between urban and rural areas are particularly prominent. A key reason for this is that a comprehensive understanding of rural women's utilization of prenatal healthcare services and their needs has not been fully established, thus failing to fully leverage pregnant women's agency in prenatal healthcare. The study aimed to identify the multi-dimensional needs of rural women in the process of utilizing prenatal healthcare services through constructing a journey map, so as to optimize the full pregnancy cycle management of this group. Methods: The study population consists of rural pregnant women who attended obstetric clinics at healthcare institutions in Northeast China from January to May 2024. A qualitative multi-method design was adopted, integrating non-structured field observation and descriptive phenomenological qualitative interviews to comprehensively gather rural women's emotions, perceptions, experiences, and needs regarding prenatal care services. Field observation provided contextual, behavioral, and environmental insights into service delivery processes and stakeholder interactions, while qualitative interviews delved deeply into the subjective lived experiences, emotional responses, and contextual factors shaping care utilization. The collected data were systematically analyzed and synthesized to construct a detailed journey map that delineates the sequential stages of prenatal care, key touchpoints, behavioral patterns, needs, pain points, and opportunities for improvement. Ethical approval was obtained from the Ethics Committee of Harbin Medical University, Daqing, No. HMUDQ20230330001. Results: The journey comprises five phases. The first stage marks the initiation of prenatal care services. Pregnant women are often unfamiliar with the procedures and have various concerns and anxieties about their upcoming pregnancy journey. In the second stage, pregnant women begin participating in non-invasive prenatal screening and start focusing on long-term nutrition and gestational weight management. In the third stage, maternal-fetal interaction increases, and ultrasound screenings for congenital anomalies become a critical task. Lifestyle changes and management pose significant challenges during this period. The fourth stage emphasizes proactive prevention and screening for pregnancy-related complications. Guiding pregnant women in self-monitoring is essential, and their needs for postpartum care for both mother and baby gradually increases. In the fifth stage, pregnant women frequently engage with prenatal care services, experiencing both anticipation and anxiety as they prepare for delivery. Conclusion: This exploratory qualitative multi-method study conducted in rural Northeast China developed a five-stage journey map of prenatal healthcare service utilization. The findings are context-specific to rural Northeast China and do not imply broad generalizability; they highlight key optimization points for prenatal care management for rural pregnant women in similar regional settings.