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

项目摘要/摘要 这个独立之路奖(K99/R00)将促进我向一名独立科学家的转变 对妇幼保健的社会、结构和卫生系统驱动因素进行创新研究 (妇幼保健)差距，并将调查结果转化为实际干预措施，以减少差距和 改善妇幼保健成果。本提案中描述的活动旨在解决医疗保健提供者 压力和无意识的偏见，以提高孕产妇保健的质量，特别是以人为本 尺寸。以人为本的孕产妇保健(PCMHC)导致孕产妇和新生儿死亡率高 撒哈拉以南非洲(SSA)的死亡率和PCMHC的差异正在推动孕产妇使用的差异 医疗服务。然而，关于如何改善PCMHC和缩小差距的研究很少。我试图填满 这个项目的差距。我建议将健康提供者的压力和无意识偏见作为基本目标 导致PCMHC不佳的因素和PCMHC的差异。健康提供者的压力和无意识的偏见是 需要考虑的重要因素是：(1)低资源环境中的提供者通常工作压力很大 条件；(2)无意识偏见在每个社会中都很普遍，包括SSA；(3)这些因素是相互作用的 加强低质量护理的驱动因素和以人为本的护理差距。让我准备好发展我的 独特的研究计划和扩大干预的证据基础，以改善PCMHC，我建议 在指导阶段(K99)的培训和研究，以扩展我在以下方面的知识和技能：(1)压力和 无意识的偏见；(2)先进的定性和混合方法研究；(3)实施科学 方法论。在K99阶段，我还将进行(1)多层次二次数据分析，以检查个人 与PCMHC相关的水平特征和潜在的系统水平应激源，重点关注 提供商压力；以及(2)对提供商进行有组织的深入访谈，以检查提供商的级别 压力和无意识的偏见，以及肯尼亚的压力源和偏见的类型。所获得的知识和技能 在指导阶段，以及指导研究的结果，将有助于实现 独立阶段(R00)的目标是：(1)设计多组分理论和基于证据的 干预措施，使提供者能够识别和管理他们的压力和无意识偏见；(2)试点 评估干预措施的可行性和可接受性；及(3)评估干预措施在以下方面的初步效果： (A)提供者与压力和无意识偏见有关的知识、态度和行为；和(B)提供者 压力水平-采用前测-后测控制组设计。我将利用试点的结果来完善 干预和制定R01建议，进行多点评估，样本更大，跟踪时间更长， 评估对PCMHC的影响。我的导师和咨询团队正准备帮助我实现 我的培训和研究目标，并确保我成功过渡到一名独立的调查员。

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.