Building TrUst and UNiting Teams Through DouLa partnErship-BUNDLE

项目摘要/摘要：捆绑包 黑人/非裔美国人(黑人/AA)分娩的人死亡率高得不成比例， 与怀孕相关的发病率。在全国范围内，黑人女性死于 与怀孕相关的原因比非西班牙裔白人女性要高，但在威斯康星州，她们患妊娠相关疾病的可能性是非西班牙裔白人女性的五倍 去死吧。威斯康星州70%的黑人人口居住在东南部的密尔沃基县 威斯康星州。造成这些差异的关键因素之一是医疗不信任，这是一种防御性反应 反对普遍存在的结构性不平等，这种不平等导致获得卫生保健资源的机会不佳。在我们的 在医疗保健系统中，我们发现黑人/AA孕妇的医疗不信任率很高。此外，一个 2021年密尔沃基县社区卫生需求评估，依托居民调查， 利益相关者与社区领导人的访谈和焦点小组发现，对医疗保健系统的信任 被确定为密尔沃基县孕产妇和婴儿健康的关键关切。要解决关键需求 为了在我们的医疗系统和威斯康星州东南部的黑人/AA生育社区之间建立信任， 我们的团队与一个以社区为基础的助产士组织，非裔美国人母乳喂养组织合作 网络(AABN)。以社区为基础的助产士在解决孕产妇健康危机方面是不可或缺的，方法是多样化 产前劳动力，并作为母亲的倡导者和情感支持者 卫生系统。大量研究表明，以社区为基础的双胞胎与较低的患病几率相关 剖腹产、早产和产后抑郁症。然而，目前，AABN Doulas和任何其他 在威斯康星州，社区助产士与医疗保健专业人员分开运作。这导致了好坏参半 医院职工对产程接受助产士的态度。到目前为止，还没有尝试过任何努力 融合这些群体的长处，以改善整个区域的孕产妇健康。我们的中心假设是 早期将以社区为基础的助产士整合到产前护理中，通过联合和 使围产期劳动力多样化，并改善孕产妇健康结果。我们计划检验这一假设 这是一项混合方法研究，题为通过Doula伙伴关系建立信任和联合团队(BRAND)， 使用三个具体目标：目标1：制定医疗服务提供者和 威斯康星州东南部的社区杜拉，目标2：比较综合方案的效果 将产前护理模式转变为标准的产前护理，以提高保健参与度和信任度，并减少 不利后果，以及目标3：向学术和社区论坛传播研究结果，并积极 寻求制度和政策层面变革的机会。在建议的研究完成后，我们 期望找出黑人分娩人群医疗不信任的驱动因素，并建立可持续的 通过多元化和统一的围产期劳动力建立信任的一体化助产士-临床医生模式，改善了 卫生保健参与度，并减少严重的孕产妇发病率。

PROJECT SUMMARY/ABSTRACT: BUNDLE Black/African American (Black/AA) birthing people experience disproportionately higher rates of mortality and morbidity associated with pregnancy. Nationwide, Black women are three times more likely to die from pregnancy-related causes than non-Hispanic white women, but in Wisconsin, they are five times more likely to die. 70% of the Black population of Wisconsin resides in Milwaukee County, which is in Southeastern Wisconsin. One of the key factors contributing to these disparities is medical mistrust, a defensive reaction against prevailing structural inequities that leads to suboptimal access to healthcare resources. In our healthcare system, we found high rates of medical mistrust among Black/AA pregnant people. Moreover, a 2021 Community Health Needs Assessment conducted in Milwaukee County, relying on residents’ survey, stakeholders’ interviews and focus groups with community leaders, found that trust in the health care system was identified as key concern for maternal and infant health in Milwaukee County. To address the critical need to build trust between our healthcare system and Black/AA birthing communities in Southeastern Wisconsin, our team has partnered with a community-based doula organization, the African American Breastfeeding Network (AABN). Community-based doulas are integral in addressing the maternal health crisis by diversifying the prenatal workforce and serving as advocates and emotional supporters for mothers as they navigate the health system. Numerous studies demonstrate that community-based doulas are associated with lower odds of cesarean, preterm birth, and postpartum depression. However, currently, AABN doulas and any other community-based doulas operate separately from healthcare professionals in Wisconsin. This leads to mixed attitudes on acceptance of doulas on labor and delivery by hospital staff. To date, no effort has been attempted to merge the strengths of these groups to improve maternal health across the region. Our central hypothesis is that earlier integration of community-based doulas in prenatal care reduces medical mistrust by uniting and diversifying the perinatal workforce and improves maternal health outcomes. We plan to test this hypothesis with a mixed methods study, titled Building TrUst and UNiting Teams Through DouLa partnErship (BUNDLE), using three specific aims: Aim 1: Develop an integrated prenatal care model of medical providers and community-based doulas in Southeastern Wisconsin, Aim 2: Compare the effectiveness of the integrated prenatal care model to standard prenatal care in improving healthcare engagement and trust, and reducing adverse outcomes, and Aim 3: Disseminate findings to scholarly and community-based forums and actively pursue opportunities for systems- and policy-level change. After the proposed research is completed, we expect to identify drivers of medical mistrust for Black birthing people and the establish a sustainable integrated doula-clinician model that builds trust through a diversified and united perinatal workforce, improves healthcare engagement, and reduces severe maternal morbidity.