Mitigating the Impact of Implicit Bias on Maternal Morbidity and Mortality for African American Women

项目摘要/摘要 非裔美国人(AA)女性经历与怀孕相关的严重发病率的可能性是后者的2-4倍 死亡率比美国的白人母亲还高。与怀孕有关的产妇死亡率中有一半被认为是 可以预防，但对再生障碍性贫血妇女来说，获得高质量的护理是有问题的。含蓄的偏见、明显的种族主义和 与医疗保健提供者的文化上不适当的互动都与缺乏医疗保健有关 利用率。扩大戒酒协会妇女的声音和支持戒酒协会妇女主导的解决方案对于 实现孕产妇健康公平。这份为期一年的行政副刊中提出的工作建立在目标的基础上 《环境对儿童健康结果的影响》(ECHO)父母资助(UG3/UH3OD023285，Paneth 接触PI)，以评估孕期和围产期的环境暴露 与后来的儿童健康结果的关系。我们将从底特律回声网站招募AA女性，并密切合作 与亚特兰大Echo妊娠队列(Dunlop&Brennan，UG3/UH3OD023318)合作，登记在美国出生 黑人女性。这项研究的假设是，从再生障碍性贫血女性及其医疗保健中获得指导 通过生殖正义、尊重关怀和健康公平的视角，提供者可以提供关键的 有助于改善再生障碍性贫血妇女在卫生保健环境中的治疗及其利用的重要信息 和参与保健，从而减少在不利的孕产妇健康结果方面的差距。穿过 与再生障碍性贫血母亲、医疗保健提供者和社区团体进行访谈和焦点小组，目的是1) 确定减少隐性偏见和种族主义对再生障碍性贫血妇女健康影响的促进者和障碍 护理环境，基于关键告密者的投入，包括处于风险中的AA妇女和卫生保健提供者； 以及2)制定战略，以优化对再生障碍性贫血母亲的医疗服务的利用和有效性。 这项全范围的研究在从AA妇女和她们的医疗保健提供者那里获得指导方面具有创新性 通过生殖正义、尊重关怀和健康公平的视角，它将有助于更好地 了解Echo的产前、围产期和产后健康状况。它对于批判性的发现具有重要意义 改善再生障碍性贫血妇女在卫生保健环境中的治疗的重要信息将提高参与度 在卫生保健方面，从而减少不良孕产妇健康结果方面的差距。其结果将是 为母亲制定具体策略工具包，以应对负面互动和获得患者 集中的、尊重的关怀。目标是通过发现妇女和提供者的机制来赋予妇女权力 可以用来减少无意识或隐含的偏见在医疗保健环境中的影响，从而减少 有严重发病率和死亡率的风险。

Project Summary/Abstract African American (AA) women are 2-4 times more likely to experience pregnancy-related severe morbidity and mortality than are white mothers in the US. Half of pregnancy-related maternal mortality is judged to be preventable, but access to quality care is problematic for AA women. Implicit bias, perceived racism and culturally inappropriate interactions with health care providers have all been linked to a lack of health care utilization. The amplification of AA women's voices and the support of AA women-led solutions are critical to achieving maternal health equity. The work proposed in this 1-yr Administrative Supplement builds on the aims of the Environmental influences on Child Health Outcomes (ECHO) parent grant (UG3/UH3OD023285, Paneth Contact PI), which are to assess environmental exposures during pregnancy and the perinatal period in relation to later child health outcomes. We will enroll AA women from our Detroit ECHO site and work closely with the Atlanta ECHO pregnancy cohort (Dunlop & Brennan, UG3/UH3OD023318), which enrolls US-born Black women. The hypothesis for this study is that eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity, can offer critically important information useful in improving AA women's treatment in the health care setting and their utilization and participation in health care, thereby reducing disparities in adverse maternal health outcomes. Through interviews and focus groups with AA mothers, health care providers, and community groups, the aims are to 1) identify facilitators and barriers for mitigating the impact of implicit bias and racism on AA women in the health care setting, based on input from key informants, including both AA women at risk and health care providers; and 2) develop strategies that will optimize utilization and effectiveness of healthcare services for AA mothers. This ECHO-wide study is innovative in eliciting guidance from AA women and their health care providers through the lens of reproductive justice, respectful care, and health equity and it will contribute to better understanding of ECHO's Pre, Peri, and Postnatal health outcomes. It is significant in discovering critically important information for improving AA women's treatment in health care settings that will improve participation in health care, thereby reducing disparities in adverse maternal health outcomes. The result will be the development of a toolkit of specific strategies for mothers to counter negative interactions and obtain patient centered, respectful care. The goal is to empower women by discovering mechanisms women and providers can employ to lessen the impact of unconscious or implicit bias in the health care setting and thus reduce the risk of severe morbidity and mortality.