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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

基本信息

批准号：
10227808
负责人：
Patience A Afulani
金额：
$ 24.4万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10227808
关键词：
Address Adult Affect Africa South of the Sahara Area Attention Automobile Driving Award Behavior Biological Markers Birth Caring Characteristics Childbirth Conscious Consult Consultations Control Groups County Data Data Analyses Dimensions Educational Curriculum Effectiveness Ensure Environment Evaluation Evidence based intervention Family Feedback Goals Health Health Knowledge, Attitudes, Practice Health Personnel Health Services Health care facility Health system Individual Intervention Interview Kenya Knowledge Lead Leadership Learning Maternal Health Services Maternal Mortality Maternal and Child Health Measures Mentors Mentorship Methodology Neonatal Mortality Outcome Pathway interactions Patients Pattern Phase Pregnancy Outcome Process Process Measure Provider Qualitative Methods Quality of Care Research Research Methodology Research Personnel Resources Role Sampling Scientist Self Efficacy Services Site Societies Socioeconomic Status Stress Structure System Trainers Training Training Translating Trauma Unconscious State Woman Work acceptability and feasibility behavior change career design disability disparity reduction effective intervention evidence base experience follow-up health care disparity health disparity implementation process implementation science improved innovation intervention effect low and middle-income countries maternal morbidity multi-component intervention neonatal outcome person centered preference pregnancy related death programs provider factors psychologic response simulation skills social cognitive theory social structure stem stressor theories therapy design unconscious bias

项目摘要

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.

项目总结/文摘