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Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care

Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care
解决医疗服务提供者的压力和无意识偏见,以提高孕产妇保健质量
批准号:
10227808
负责人:
Patience A Afulani
金额:
$24.4万
依托单位国家:
美国
项目类别:
财政年份:
2020
资助国家:
美国
项目状态:
已结题
起止时间:
2020-09-01 至 2023-08-31
关键词:
AddressAdultAffectAfrica South of the SaharaAreaAttentionAutomobile DrivingAwardBehaviorBiological MarkersBirthCaringCharacteristicsChildbirthConsciousConsultConsultationsControl GroupsCountyDataData AnalysesDimensionsEducational CurriculumEffectivenessEnsureEnvironmentEvaluationEvidence based interventionFamilyFeedbackGoalsHealthHealth Knowledge, Attitudes, PracticeHealth PersonnelHealth ServicesHealth care facilityHealth systemIndividualInterventionInterviewKenyaKnowledgeLeadLeadershipLearningMaternal Health ServicesMaternal MortalityMaternal and Child HealthMeasuresMentorsMentorshipMethodologyNeonatal MortalityOutcomePathway interactionsPatientsPatternPhasePregnancy OutcomeProcessProcess MeasureProviderQualitative MethodsQuality of CareResearchResearch MethodologyResearch PersonnelResourcesRoleSamplingScientistSelf EfficacyServicesSiteSocietiesSocioeconomic StatusStressStructureSystemTrainers TrainingTrainingTranslatingTraumaUnconscious StateWomanWorkacceptability and feasibilitybehavior changecareerdesigndisabilitydisparity reductioneffective interventionevidence baseexperiencefollow-uphealth care disparityhealth disparityimplementation processimplementation scienceimprovedinnovationintervention effectlow and middle-income countriesmaternal morbiditymulti-component interventionneonatal outcomeperson centeredpreferencepregnancy related deathprogramsprovider factorspsychologicresponsesimulationskillssocial cognitive theorysocial structurestemstressortheoriestherapy designunconscious bias

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PROJECT SUMMARY/ABSTRACT This Pathway to Independence Award (K99/R00) will facilitate my transition to an independent scientist who conducts innovative research on the social, structural, and health system drivers of maternal and child health (MCH) disparities, and translates the findings into practical interventions that will reduce disparities and improve MCH outcomes. The activities described in this proposal are aimed at addressing health care provider stress and unconscious bias to improve quality of maternal health care, particularly the person-centered dimensions. Poor person-centered maternal health care (PCMHC) contributes to high maternal and neonatal mortality in sub-Saharan Africa (SSA), and disparities in PCMHC are driving disparities in use of maternal health services. Little research, however, exists on how to improve PCMHC and reduce disparities. I seek to fill this gap with this project. I propose targeting health provider stress and unconscious bias as fundamental factors driving poor PCMHC and disparities in PCMHC. Health provider stress and unconscious bias are important to consider because: (1) providers in low-resource settings often work under very stressful conditions; (2) unconscious bias is prevalent in every society including SSA; and (3) these factors are mutually reinforcing drivers of poor quality care and disparities in person-centered care. To prepare me to develop my unique research program and extend the evidence base on interventions to improve PCMHC, I propose training and research during the mentored phase (K99) to extend my knowledge and skills in: (1) stress and unconscious bias; (2) advanced qualitative and mixed methods research; and (3) implementation science methodology. In the K99 phase, I will also conduct (1) multilevel secondary data analysis to examine individual level characteristics and potential system level stressors associated with PCMHC, focusing on the role of provider stress; and (2) structured and in-depth interviews with providers to examine the levels of provider stress and unconscious bias, and the types of stressors and biases in Kenya. The knowledge and skills gained in the mentored phase, as well as the results of the mentored research, will be instrumental to achieving the aims of the independent phase (R00), which are to: (1) design a multicomponent theory and evidence-based intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on: (a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider stress levels—using a pretest-posttest control group design. I will use the results of the pilot to refine the intervention and develop an R01 proposal for a multi-site evaluation with a larger sample and longer follow up, to assess impact on PCMHC. My mentorship and consulting team is uniquely poised to assist me in achieving my training and research goals, and to ensure my successful transition to an independent investigator.
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Caring for Providers to Improve Patient Experience (CPIPE) Study
Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care
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