"JUST BECAUSE YOU HAVE EARS DOESN'T MEAN YOU CAN HEAR"-PERCEPTION OF RACIAL-ETHNIC DISCRIMINATION DURING CHILDBIRTH
"JUST BECAUSE YOU HAVE EARS DOESN'T MEAN YOU CAN HEAR"-PERCEPTION OF RACIAL-ETHNIC DISCRIMINATION DURING CHILDBIRTH
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DOI：
10.18865/ed.30.4.533
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发表时间：
2020-09-01
影响因子：
3.2
通讯作者：
Howell, Elizabeth A.
中科院分区：
文献类型：
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作者：
Janevic, Teresa;Piverger, Naissa;Howell, Elizabeth A.
背景：纽约市的黑人和拉丁裔妇女在分娩过程中出现潜在危及生命的疾病的可能性是白人妇女的两倍。医疗保健质量被认为在这种明显的差距中发挥了作用，而患者与提供者的沟通是医疗保健质量的一个方面。感知到的保健歧视可能影响患者与提供者的沟通，但在出生住院期间尚未得到充分探讨。目的：我们的目的是调查在医院分娩的黑人和拉丁裔妇女中，感知到的种族-民族歧视对患者-提供者沟通的影响。方法：我们对过去一年中在纽约市一家大医院分娩的黑人和拉丁裔妇女（n=27）进行了四个焦点小组的研究。和谐种族/民族的主持人就妇女在分娩住院期间的经历和与卫生保健提供者的互动提出了一系列问题。一组用西班牙语进行。我们采用了综合分析方法。我们使用了适用于批判种族理论的弱势群体行为模型作为开始的概念模型。两位分析人员对突发主题的文本进行演绎编码，使用不断比较的方法来协调和完善代码结构。代码被分类为主题，并被分配到概念模型类别。结果：在我们的概念模型中，患者的易感因素是交叉身份（例如，移民/拉丁裔或黑人/医疗补助接受者），种族意识(“……作为一个有色人种的女人，如果我不够自信，如果我不愿意问，那么他们就不会努力回答”)，以及社会上指定的种族（例如，“你的长相，你的说话方式”）。我们将差别待遇的主题分类为阻碍因素，其中包括在以前的研究中被忽视的因素，如与婴儿父亲的关系和房间分配引起的感知差别待遇。差别待遇的主题与消极的提供者沟通属性（例如，非人情味，判断性）或经验（例如，不被倾听，给予低优先级，不尊重偏好）同时发生。结论：分娩过程中感知到的种族-民族歧视会影响患者与医疗服务提供者的沟通，这是患者体验中一个重要且可能改变的方面。减少产科保健差距的干预措施应从提供者和患者的角度解决所察觉到的歧视问题。
Background: Black and Latina women in New York City are twice as likely to experience a potentially life-threatening morbidity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization.Purpose: Our objective was to investigate the impact of perceived racial-ethnic discrimination on patient-provider communication among Black and Latina women giving birth in a hospital setting.Methods: We conducted four focus groups of Black and Latina women (n=27) who gave birth in the past year at a large hospital in New York City. Moderators of concordant race/ethnicity asked a series of questions on the women's experiences and interactions with health care providers during their birth hospitalizations. One group was conducted in Spanish. We used an integrative analytic approach. We used the behavioral model for vulnerable populations adapted for critical race theory as a starting conceptual model. Two analysts deductively coded transcripts for emergent themes, using constant comparison method to reconcile and refine code structure. Codes were categorized into themes and assigned to conceptual model categories.Results: Predisposing patient factors in our conceptual model were intersectional identities (eg, immigrant/Latina or Black/Medicaid recipient), race consciousness (" ... as a woman of color, if I am not assertive, if I am not willing to ask, then they will not make an effort to answer"), and socially assigned race (eg, "what you look like, how you talk"). We classified themes of differential treatment as impeding factors, which included factors overlooked in previous research, such as perceived differential treatment due to the relationship with the infant's father and room assignment. Themes for differential treatment co-occurred with negative provider communication attributes (eg, impersonal, judgmental) or experience (eg, not listened to, given low priority, preferences not respected).Conclusions: Perceived racial-ethnic discrimination during childbirth influences patient-provider communication and is an important and potentially modifiable aspect of the patient experience. Interventions to reduce obstetric health care disparities should address perceived discrimination, both from the provider and patient perspectives.