Reducing Disparities among African American Women Seeking Infertility Treatment

摘要 黑人妇女患不孕症的可能性是非黑人妇女的两倍，但寻求治疗的可能性是非黑人妇女的两倍。 西班牙裔白色女性。关于黑人不孕妇女治疗决策的研究很少， 对他们的生殖经验缺乏全面的了解。未经治疗的黑人女性不孕症 经历的问题，如高度孤立，沉默，和负面的医疗经验，但很少是 了解哪些因素影响开始和完成护理的决定。本研究的目的是 了解是什么影响黑人妇女不孕症开始和完成治疗。的具体目标 本研究的目的是：1）确定生物学、临床和社会文化因素，预测不孕症的完成 在已经开始治疗的黑人妇女中制定治疗计划; 2）制定一个多层面的 描述和概念化的黑人妇女的看法，生物，临床，社会文化的影响 决定开始和完成不孕症的治疗。本研究将采用一种收敛的混合方法 方法结合数据从一个回顾性图表审查和个人半结构化访谈。 生物学（年龄、BMI、既往病史/手术史/妇科史、不孕类型）、临床（诊断结果 和建议的治疗计划），以及黑人的社会文化（保险，就业状况，婚姻状况）数据 将通过回顾性图表审查从大型不孕症诊所提取患有不孕症的妇女。 同时，将对在同一诊所开始护理的黑人妇女进行有目的的抽样调查， 采访了他们对生物学（健康和不孕的看法/态度/信念） 和不孕症的影响），临床（临床遭遇的看法，患者与提供者的关系， 治疗计划的看法）和社会文化（宗教、教育、就业、婚姻状况、种族 识别、培养不孕症的意义和社会支持）因素影响了他们开始和 完全照顾。从这项拟议的研究中产生的知识将确定目前未知的影响 关于不孕症黑人女性的临床经验此外，研究结果将有助于为自我管理提供信息 针对可改变因素的干预措施，针对最需要这些措施的黑人妇女亚群体， 旨在改善健康差距的针对社会决定因素的干预措施和政策制定 影响黑人女性不孕症根据该奖项提出的培训将满足未来的目标， 制定一项深思熟虑的研究计划，重点是改善黑人妇女的家庭建设经验 作为一个健康差距护士研究人员使用混合方法的方法。杜克大学和其他公立 私人机构将提供丰富的环境和独特的资源来完成这项研究。

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.