Validating a path model of adherence to prenatal care recommendations among pregnant women

•Validated path model to show influences on prenatal care recommendation adherence.•Used evidence-based proposed theoretical framework.•Identified best-fit path model for adherence to prenatal care recommendations.•Found motivation and shared decision-making predicted adherence. To date, no study has reported a diagrammatic path model that involves patient-provider communication on pregnant women’s adherence to prenatal care recommendations. To bridge this gap, this study aimed to validate a path model to display the direct and indirect influences on adherence to prenatal care recommendations. A cross-sectional study founded on an evidence-based proposed theoretical framework was conducted among pregnant women (18–45 years) in their second or third trimester (n = 401) in the Midwestern United States. The proposed theoretical framework examined multiple levels of influences. Previously validated instruments were pilot tested and modified. Path analysis was conducted to validate the best-fit path model. The path model showed shared decision-making and motivation significantly predicted adherence to prenatal care recommendations and accounted for 10% (R2) of the variance. Cultural competency, interaction, perceived discrimination, and satisfaction accounted for 30% (R2) of the variance of shared decision-making. Patient’s trust, distrust, and self-efficacy accounted for 5% (R2) of motivation’s variance. Our work identified the best-fit path model for adherence to prenatal care recommendations. Incorporating findings from this study could assist prenatal care providers in understanding many complex variables affecting prenatal care, ultimately reducing infant mortality.