ArticleBMC pregnancy and childbirth2026
Implementation and evaluation of a secret shopper methodology to examine access to prenatal care for patients with opioid use disorder.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMaternal opioid use disorder (OUD) has risen exponentially in the US, impacting pregnancy outcomes. This analysis describes and evaluates a secret shopper methodology for prenatal capacity and quality care research, addressing key considerations for study design. In recent years, this innovative methodology has gained popularity in research to obtain unbiased data on patient experiences in real-time. However, there is a lack of research on accessing prenatal care for pregnant patients with OUD. This analysis provides a comprehensive assessment of the secret shopper methodology's application in the prenatal care setting for patients with OUD.
methodsA trained group of racially and ethnically diverse callers followed a standardized script and used Google Voice numbers to call randomly selected prenatal care providers throughout Florida. The sample was obtained via geocoding providers, assessing the sampling frame for equal probability of provider selection, stratified randomized sampling in each of the 11 Agency for Health Care Administration regions, assigning an order of calls for providers with multiple locations, and blocked randomization of providers. The approach was pilot tested, and the protocol iteratively refined based on feedback loops from callers and a reflective Advisory Committee of parents with lived experience.
resultsEvaluation of this methodology was guided by key domains and constructs from the Consolidated Framework in Implementation Research. The methodology's relative advantage over traditional research methods, trialability, adaptability, cost-effectiveness, and telephonic approach allowed for a greater reach of physicians statewide, providing unique insights into healthcare access and quality.
conclusionThe study identified lessons learned during development and implementation, emphasizing the need for piloting, stakeholder support, and multidisciplinary collaboration to address unforeseen issues and ensure effective implementation. The methodology uncovered the challenges faced by pregnant individuals with OUD when seeking prenatal care and demonstrates the utility of secret shopper methods in assessing various facets of healthcare.
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