Assessing Native Hawaiian and Pacific Islander Maternal Outcomes and Health Care Experiences

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PROJECT SUMMARY The purpose of this K01 award is to support research training and advance the career development of Dr. Rebecca Delafield. Dr. Delafield’s long-term career goal is to establish an independent research program focused on improving maternal health and health care outcomes for Native Hawaiian and Pacific Islanders (NHPI). Research Plan: Maternal mortality and morbidity are increasing in the U.S. A recent study from Hawai‘i found that NHPI accounted for 44% of the maternal deaths, although they make up only 25% of the state population. Beyond this single study, NHPI maternal mortality is largely invisible. Federal agencies do not publish maternal mortality rates of NHPIs. This void is exacerbated by a dearth of research on other major and more common maternal health outcomes, such as severe maternal morbidity (SMM) (e.g., eclampsia and hemorrhage). Yet, a small body of research suggests NHPI communities face obstacles accessing the healthcare system and engaging with health care providers, which may compromise care in pregnancy. NHPI women may also have unique cultural perspectives on childbearing which could mitigate or exacerbate these challenges. To comprehensively address maternal health among NHPIs, research is needed to 1) assess critical maternal outcomes for NHPIs 2) better characterize NHPI experiences, and 3) identify key factors related the processes and quality of maternity care. There are two research aims: 1) Compare rates of SMM in NHPI women to non-Hispanic white women by analyzing hospital discharge data from facilities in Hawaiʻi, Oregon, and Washington. 2) Survey 300 NHPI women to assess patient-clinician relationship and communication factors associated with high-quality person-centered care, perceived discrimination, and engagement in prenatal care. Career Plan: This project will provide the candidate the mentoring and training needed in the areas of scientific and statistical methodologies for small populations, community-engaged research and health communication to achieve her long-term career goal and short-term objectives. The third (training) aim is: Complete a rigorous training program to advance skills in small population health research and statistical methods, survey analysis, and community-engaged research. The Mentoring Team assembled has diverse skills and extensive experience in the areas of NHPI health, health disparities research, epidemiology, community-engaged research, health communication, maternal and reproductive health. Training objectives will be met through relevant coursework, mentored research training, bi-directional training with community-based partners, and hands-on learning grounded in Pacific cultural traditions. The completion of these aims will provide the candidate the experience and preliminary data needed to compete for R01 funding as an independent investigator and progress toward her future goal of developing and testing a culturally-responsive and community-engaged multilevel intervention to improve NHPI maternal and perinatal health.