The first two authors conducted all data collection. Both are trained in social science research methods including reflexivity and triangulation of multiple data sources [43, 44]. Data sources for the patient sample consisted of semi-structured interviews (n = 31); a focus group conducted during one session of an existing group prenatal visit organized for patients in the program (n = 2; only two patients attended the group prenatal visit on the date approved for conducting the focus group concurrently and both agreed to participate); and participant-observation of patient-provider and provider-provider interactions in the clinical setting (during 2 months of the overall study period). Patient interviews lasted approximately 25 min up to an hour; the focus group lasted for an hour; participant-observation took place in the clinic 2 days per week throughout the study period (October 2017 through February 2018). In the larger study, providers were interviewed as key informants (n = 10); those findings are not included here. For the subset analysis presented here, only data collected from the overall patient sample, representing the patient participants (n = 27) were re-analyzed (Table 1).

Data sources

Questions and prompts on the interview guides (Additional file 1) were informed by a review of existing literature on perinatal substance use treatment experiences, and by participant-observation. The guides included questions about participants’ experiences with and perceptions of the perinatal substance use treatment program; delivery/birth experiences (for postpartum interviews); if they felt the program had helped them achieve goals related to treatment; and if they felt the program had adequately prepared them for what would happen at delivery (postpartum interviews). The same topics guided observations during participant-observation; though observations were open-ended as and intended to inform the more formal data collection. Participant-observation was documented in de-identified fieldnotes journals, as is standard in ethnographic and anthropological fieldwork [43, 44].

Participants were interviewed one-on-one after appointments or during a break during steps of an appointment. In addition, patients in the program who met weekly in an existing group prenatal visit, typically led by one of the buprenorphine prescribers and a substance use counselor, were screened and all were found to be eligible for the interview portion of the study. Group members were asked if they were interested in having one session of their weekly prenatal group conducted as a focus group, discussing the same topics in the prenatal interview guide. All in attendance during the designated week consented, constituting a further nested opportunistic, convenience, and purposive sample. One participant in the focus group also participated in a one-on-one interview during the study period – however, that participant discussed different themes during her one-on-one interview as compared to during the triangulation focus group, her contributions were coded and analyzed separately from the two sessions. All interview and focus group participants received a Babies ‘R’ Us™ gift card worth $10.00 (U.S.) to thank them for taking time to share their perspectives.

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