Objective: 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.

Methods: 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.

Results: The path model showed shared decision-making and motivation significantly predicted adherence to prenatal care recommendations and accounted for 10% (R-2) of the variance. Cultural competency, interaction, perceived discrimination, and satisfaction accounted for 30% (R-2) of the variance of shared decision-making. Patient's trust, distrust, and self-efficacy accounted for 5% (R-2) of motivation's variance.

Conclusion: Our work identified the best-fit path model for adherence to prenatal care recommendations. Practice implications: Incorporating findings from this study could assist prenatal care providers in understanding many complex variables affecting prenatal care, ultimately reducing infant mortality.