1
|
Karvonen KL, Smith O, Chambers-Butcher B, Afulani P, Mathis-Perry T, Rangwalla K, McLemore M, Rogers EE. Parent and staff focus groups to address NICU racial inequities: "There's radical optimism in that we're in a different time and we're not doing it alone". J Perinatol 2024:10.1038/s41372-024-02063-6. [PMID: 39025956 DOI: 10.1038/s41372-024-02063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES To understand local mechanisms of racial inequities and generate recommendations from community members regarding how to promote racial equity in the Neonatal Intensive Care Unit (NICU). METHODS In an urban tertiary care NICU, 4 semi-structured in-person focus groups with follow-up audio diaries were conducted with NICU parents and staff from 2022-2023 with support from interpreters, a psychologist, and a family advocate. Researchers coded transcripts independently and thematic analysis was utilized to generate and refine themes. RESULTS 16 racially diverse and multidisciplinary staff and parents participated, and six themes emerged from the data. Mechanisms of racial inequities included power dynamics, interpersonal and institutional dehumanization, and societal inequities. Recommendations included redistributing power, transforming space and staff to promote humanism, and mitigating harm through peer support and resource allocation. CONCLUSION Focus groups are a promising strategy to identify interventions to address racial inequities. Future research should focus on intervention implementation and evaluation.
Collapse
Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
- California Preterm Birth Initiative, San Francisco, CA, USA.
| | - Olga Smith
- Independent Researcher, Antioch, CA, USA
| | - Brittany Chambers-Butcher
- California Preterm Birth Initiative, San Francisco, CA, USA
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA
| | - Patience Afulani
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Khuzaima Rangwalla
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Monica McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- California Preterm Birth Initiative, San Francisco, CA, USA
| |
Collapse
|
2
|
Kraus AC, Quist-Nelson J, Ryan S, Stuebe A, Young OM, Volz E, Montiel C, Fiel L, Aktan I, Tully KP. Postpartum care in a cardio-obstetric clinic after preterm preeclampsia: patient and healthcare provider perspectives. Am J Obstet Gynecol MFM 2024; 6:101339. [PMID: 38492641 DOI: 10.1016/j.ajogmf.2024.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Despite the significant disruption and health implications of preterm preeclampsia with severe features for birthing people, little is known about how the system of postpartum care might be strengthened for affected families. Multidisciplinary cardio-obstetric clinics are emerging; however, there is limited research on patient and healthcare provider perspectives. OBJECTIVE To describe patient and healthcare provider perspectives of services in a cardio-obstetric clinic following preterm preeclampsia with severe features. STUDY DESIGN Individuals who experienced preterm preeclampsia with severe features and presented to a cardio-obstetric clinic were approached for study participation. Providers were approached if they provided postpartum care to patients with preterm preeclampsia with severe features and considered a referral to the cardio-obstetric clinic. Participants completed a remotely conducted, semistructured interview between March 2022 and April 2023. The interviews were audio-recorded, professionally transcribed, and checked for accuracy. Responses were inductively coded for content analysis around the study questions of clinical referrals, patient education, visit expectations, and care coordination in relation to ambulatory clinical services. RESULTS Twenty participants (n=10 patients and n=10 providers) completed interviews. Healthcare system navigation was difficult, particularly in the context of postpartum needs. When patients are informed about their diagnosis, the information could both increase anxiety and be useful for long-term healthcare planning. Language concordant care did not always occur, and both patients and providers described gaps in quality services. Within the theme of responsibility, patients described needing to be vigilant, and providers recognized the gaps in referral and care coordination systems. Comprehensible patient education provided with birthing parents' companions and enhanced systems for care coordination were areas for further improvement in providing postpartum cardio-obstetric care following preterm preeclampsia. CONCLUSION This qualitative study identified patients' struggles with a confusing postpartum healthcare system and captured providers' concerns about maintaining consistent care and improving access to long-term healthcare services to improve outcomes for patients at risk of cardiovascular disease.
Collapse
Affiliation(s)
- Alexandria C Kraus
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully).
| | - Johanna Quist-Nelson
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully)
| | - Stanthia Ryan
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully)
| | - Alison Stuebe
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully); Collaborative for Maternal and Infant Health, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Stuebe and Tully)
| | - Omar M Young
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully)
| | - Elizabeth Volz
- Department of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Volz)
| | - Catalina Montiel
- Department of Pediatrics, University of North Carolina at Chapel Hill (Mrs Montiel)
| | - Lauren Fiel
- UNC Health Rex, Raleigh, North Carolina (Mrs Fiel and Dr Aktan)
| | - Idil Aktan
- UNC Health Rex, Raleigh, North Carolina (Mrs Fiel and Dr Aktan)
| | - Kristin P Tully
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Kraus, Quist-Nelson, Ryan, Stuebe, Young, and Tully); Collaborative for Maternal and Infant Health, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Stuebe and Tully)
| |
Collapse
|
3
|
Ranchoff BL, Paterno MT, Attanasio LB. Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California. J Midwifery Womens Health 2024; 69:224-235. [PMID: 38164766 DOI: 10.1111/jmwh.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type. METHODS For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences. RESULTS Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences. DISCUSSION Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.
Collapse
Affiliation(s)
- Brittany L Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Mary T Paterno
- Baystate Midwifery and Women's Health, Springfield, Massachusetts
| | - Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| |
Collapse
|
4
|
Afulani PA, Coleman-Phox K, Leon-Martinez D, Fung KZ, Martinez E, Garza MA, McCulloch CE, Kuppermann M. Psychometric assessment of the US person-centered prenatal and maternity care scales in a low-income predominantly Latinx population in California. BMC Womens Health 2023; 23:616. [PMID: 37978490 PMCID: PMC10656820 DOI: 10.1186/s12905-023-02721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States-the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales-in a low-income predominantly Latinx population in California. METHODS Data were collected from July 2020 to June 2023 from surveys of low-income pregnant and birthing people in Fresno, California, participating in the "Engaging Mothers and Babies; Reimagining Antenatal Care for Everyone" (EMBRACE) trial. Research staff administered the 26-item PCPC-US scale at 30-34 weeks' gestation (n = 315) and the 35-item PCMC-US scale at 10-14 weeks after birth (n = 286), using the language preferred by the participant (English or Spanish). We assessed construct, criterion, and known group validity and internal consistency of the scales. RESULTS 78% of respondents identified as Latinx. Factor analysis identified one dominant factor for each scale that accounted for over 60% of the cumulative variance, with most items loading at > 0.3. The items also loaded adequately on sub-scales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." Cronbach's alpha for the full scales were > 0.9 and between 0.70 and 0.87 for the sub-scales. Summative scores range from 0 to 100, with higher scores indicating higher person-centered care. Correlations with scores on scales measuring prenatal care quality and birth experience provided evidence for criterion validity, while associations with known predictors provided evidence for known-group validity. CONCLUSIONS The PCPC-US and PCMC-US scales, which were developed using a community-engaged process and found to have good psychometric properties in a largely high-income sample of Black women, were shown to also have good psychometric properties in a sample of low-income primarily Latinx women. Both scales provide valid and reliable tools to measure person-centered care experiences among minoritized communities to support efforts to reduce existing birth inequities.
Collapse
Affiliation(s)
- Patience A Afulani
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA.
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Daisy Leon-Martinez
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Kathy Z Fung
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Erica Martinez
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, USA
| | - Mary A Garza
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno, USA
- Department of Public Health, College of Health and Human Services, California State University, Fresno, USA
| | - Charles E McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| |
Collapse
|
5
|
Zhong X, Hu R, Afulani PA, Li X, Guo X, He T, Li D, Li Z. Cross-cultural adaptation and psychometric properties of the Chinese version of the Person-Centered Maternity Care Scale. BMC Pregnancy Childbirth 2023; 23:652. [PMID: 37689683 PMCID: PMC10492356 DOI: 10.1186/s12884-023-05959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Increasing evidence show that women across the world face unacceptable mistreatment during childbirth. Person-centered maternity care is fundamental and essential to quality of healthcare services. The aim of this study was to translate and determine the psychometric properties of the Person-Centered Maternity Care (PCMC) Scale among Chinese postpartum women. METHODS A cross-sectional study was conducted among 1235 post-partum women in China. The cross-cultural adaptation process followed the Beaton intercultural debugging guidelines. A total of 1235 women were included to establish the psychometric properties of the PCMC. A demographic characteristics form and the PCMC were used for data collection. The psychometric properties of the PCMC were evaluated by examining item analysis, exploratory factor analysis, known-groups discriminant validity, and internal consistency. RESULTS The number of extracted common factors was limited to three (dignity & respect, communication & autonomy, supportive care), explaining a total variance of 40.8%. Regarding internal consistency, the Cronbach's alpha coefficient and split-half reliability of the full PCMC score were 0.989 and 0.852, respectively. CONCLUSIONS The Chinese version of the PCMC is a reliable and valid tool to assess person-centered care during childbirth in China.
Collapse
Affiliation(s)
- Xiaoying Zhong
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Rong Hu
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Patience A Afulani
- Department of Epidemiology and Biostatistics, University of California, San San Francisco, California, USA
| | - Xixi Li
- Department of Nursing, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China Philippines Women's University, Manila, Philippines.
| | - Xiujing Guo
- Department of Nursing, West China Second University Hospital, Sichuan University / Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Tingting He
- Nephrology department, The Third Hospital of Mianyang, Sichuan Mental Health Center/ The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, China
| | - Dehua Li
- Department of Nursing, West China Second University Hospital, Sichuan University / Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zuowei Li
- Department of Nursing, The Third Hospital of Mianyang, Sichuan Mental Health Center/ The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, China
| |
Collapse
|
6
|
Soled KRS, Clark KD, Altman MR, Bosse JD, Thompson RA, Squires A, Sherman ADF. Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity. Res Nurs Health 2022; 45:621-632. [PMID: 36321331 PMCID: PMC9704510 DOI: 10.1002/nur.22274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kodiak R. S. Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, New Hampshire, USA
| | - Molly R. Altman
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Jordon D. Bosse
- School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Roy A. Thompson
- Sinclair School of Nursing, University of Missouri, Colombia, Missouri, USA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| |
Collapse
|