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

项目摘要 该K01奖项的目的是支持研究培训和促进博士的职业发展。 丽贝卡·德拉菲尔德德拉菲尔德博士的长期职业目标是建立一个独立的研究计划 重点是改善夏威夷土著和太平洋岛民的孕产妇保健和保健成果 （NHPI）。研究计划：美国的孕产妇死亡率和发病率正在上升。 发现NHPI占孕产妇死亡的44%，尽管他们只占该州的25% 人口除了这一项研究之外，《国家保健倡议》的孕产妇死亡率基本上是不可见的。联邦机构不会公布 国家保健机构的产妇死亡率。对其他主要和更重要的问题缺乏研究， 常见的孕产妇健康结果，如严重孕产妇发病率（SMM）（例如，子痫和 出血）。然而，一小部分研究表明，NHPI社区面临着获得 卫生保健系统和与卫生保健提供者接触，这可能会影响怀孕期间的护理。NHPI 妇女在生育方面也可能有独特的文化观点，这可能会减轻或加剧这些问题。 挑战为了全面解决国家卫生保健机构中的孕产妇健康问题，需要进行研究，以1）评估关键的 NHPI的孕产妇结局2）更好地描述NHPI经验，3）确定与NHPI相关的关键因素， 产妇护理的程序和质量。研究目的有二：1）比较NHPI妇女中SMM的发生率 非西班牙裔白色妇女，通过分析医院出院数据，从设施在夏威夷，俄勒冈州， 华盛顿。2)调查300名NHPI妇女，以评估医患关系和沟通因素 与高质量的以人为本的护理，感知歧视和参与产前护理有关。 职业规划：该项目将为候选人提供科学领域所需的指导和培训。 小人口的统计方法、社区参与的研究和卫生宣传， 实现长期职业目标和短期目标。第三个（培训）目标是：完成一个严格的 培训方案，以提高小人口健康研究和统计方法，调查分析， 和社区参与的研究。组建的指导团队拥有各种技能和丰富的经验 在NHPI健康，健康差异研究，流行病学，社区参与的研究，健康领域， 传播、孕产妇和生殖健康。培训目标将通过相关课程实现， 指导研究培训，与社区合作伙伴的双向培训，以及实践学习 以太平洋文化传统为基础。完成这些目标将为候选人提供经验 作为独立研究者竞争R01资金所需的初步数据， 她未来的目标是开发和测试一种文化敏感和社区参与的多层次干预措施， 改善《国家保健计划》的孕产妇和围产期保健。

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 Federal agencies do not publish maternal mortality rates of NHPIs.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.