Building TrUst and UNiting Teams Through DouLa partnErship-BUNDLE

项目总结/摘要：捆绑包 黑人/非洲裔美国人（黑人/AA）生育的人经历不成比例的高死亡率， 与怀孕有关的疾病。在全国范围内，黑人妇女死于 怀孕相关的原因比非西班牙裔白色妇女，但在威斯康星州，他们是五倍以上的可能性， 死的威斯康星州70%的黑人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上的不信任， 反对普遍存在的结构性不平等，这种不平等导致获得医疗保健资源的机会不佳。在我们 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。而且 在密尔沃基县开展的2021年社区卫生需求评估，依托居民调查， 利益相关者的采访和焦点小组与社区领袖，发现在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问题。为了满足 为了在我们的医疗保健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， 我们的团队与社区导乐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是解决孕产妇健康危机的组成部分， 产前劳动力，并作为母亲的倡导者和情感支持者，因为他们导航 卫生系统。许多研究表明，以社区为基础的导乐与较低的风险有关。 剖宫产、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，以社区为基础的导乐师与医疗保健专业人员分开运作。这导致混合 医护人员对导乐分娩的接受态度。迄今为止， 将这些团体的力量结合起来，以改善整个区域的孕产妇健康。我们的核心假设是 早期将社区导乐师纳入产前护理， 使围产期劳动力多样化，并改善孕产妇保健成果。我们计划测试这个假设 通过一项混合方法研究，名为通过DouLa伙伴关系建立信任和团结团队（捆绑）， 采用三个具体目标：目标1：制定一个医疗提供者的综合产前护理模式， 威斯康星州东南部社区导乐，目标2：比较综合导乐的有效性 产前护理模式到标准产前护理，以提高医疗保健参与度和信任度， 目标3：向学术和社区论坛传播研究结果， 寻求系统和政策层面变革的机会。在研究完成后，我们 希望确定对黑人生育者的医疗不信任的驱动因素，并建立一个可持续的 通过多元化和统一的围产期劳动力建立信任的综合助产士-临床医生模式， 卫生保健参与，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.