Reducing Disparities among African American Women Seeking Infertility Treatment

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Abstract Black women are two times more likely to experience infertility, yet twice less likely to seek treatment than non- Hispanic White women. Research on treatment decisions among Black women with infertility is scarce and provide incomplete understanding of their reproductive experiences. Black women with untreated infertility experience issues such as high levels of isolation, silence, and negative medical experiences, yet little is known about what factors influences decisions to initiate and complete care. The purpose of this study is to understand what influences Black women with infertility to initiate and complete treatment. The specific aims of this study are to: 1) Identify biological, clinical, and sociocultural factors that predict completion of infertility treatment plans among Black women who have initiated treatment; and 2) Generate a multidimensional description and conceptualization of Black women’s perceptions of biological, clinical, socio-cultural influences on decisions to initiate and complete treatment for infertility. This study will utilize a convergent mixed methods approach combining data from a retrospective chart review and individual semi-structured interviews. Biological (age, BMI, past medical/surgical/gynecological history, type of infertility), clinical (diagnostic results and proposed treatment plan), and sociocultural (insurance, employment status, marital status) data of Black women with infertility from a large infertility clinic will be extracted through a retrospective chart review. Concurrently, a purposive sample of Black women who have initiated care at the same clinic will be interviewed regarding their perspectives of how biological (perceptions/attitudes/beliefs of health and infertility and impact of infertility), clinical (perceptions of clinical encounter, patient-provider relationship, and perceptions of treatment plan), and sociocultural (religion, education, employment, marital status, racial identify, culture significance of infertility, and social support) elements influenced their decisions to initiate and complete care. The knowledge generated from this proposed study will identify currently unknown influences on clinical experiences among Black women with infertility. Moreover, results will help inform self-management interventions for modifiable factors, target sub-populations of Black women who are in most need of these interventions, and policy development addressing social determinants aimed at improving health disparities affecting Black women with infertility. The training proposed under this award will satisfy future goals to develop a thoughtful program of research focused on improving the family building experience of Black women as a health disparities nurse researcher using mixed methods approaches. Duke University and other public and private institutions will provide a rich environment with unique resources to complete this study.