Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care

解决医疗服务提供者的压力和无意识偏见，以提高孕产妇保健质量

基本信息

批准号：
10203087
负责人：
Patience A Afulani
金额：
$ 24.9万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10203087
关键词：
Address Adult Affect Africa South of the Sahara Area Attention Automobile Driving Award Behavior Biological Markers Birth Caring Characteristics Childbirth Conscious Consult Consultations Control Groups County Data Data Analyses Dimensions Educational Curriculum Effectiveness Ensure Environment Evaluation Evidence based intervention Family Feedback Goals Health Health Knowledge, Attitudes, Practice Health Personnel Health Services Health care facility Health system Individual Intervention Interview Kenya Knowledge Lead Leadership Learning Maternal Health Services Maternal Mortality Maternal and Child Health Measures Mentors Mentorship Methodology Neonatal Mortality Outcome Pathway interactions Patients Pattern Phase Pregnancy Outcome Process Process Measure Provider Qualitative Methods Quality of Care Research Research Methodology Research Personnel Resources Role Sampling Scientist Self Efficacy Services Site Societies Socioeconomic Status Stress Structure System Trainers Training Training Translating Trauma Unconscious State Woman Work behavior change career design disability disparity reduction effective intervention evidence base experience follow-up health care disparity health disparity implementation science improved innovation intervention effect low and middle-income countries maternal health care maternal morbidity multi-component intervention neonatal outcome person centered preference pregnancy related death programs psychologic response simulation skills social cognitive theory social structure stem stressor theories therapy design unconscious bias

项目摘要

PROJECT SUMMARY/ABSTRACT This Pathway to Independence Award (K99/R00) will facilitate my transition to an independent scientist who conducts innovative research on the social, structural, and health system drivers of maternal and child health (MCH) disparities, and translates the findings into practical interventions that will reduce disparities and improve MCH outcomes. The activities described in this proposal are aimed at addressing health care provider stress and unconscious bias to improve quality of maternal health care, particularly the person-centered dimensions. Poor person-centered maternal health care (PCMHC) contributes to high maternal and neonatal mortality in sub-Saharan Africa (SSA), and disparities in PCMHC are driving disparities in use of maternal health services. Little research, however, exists on how to improve PCMHC and reduce disparities. I seek to fill this gap with this project. I propose targeting health provider stress and unconscious bias as fundamental factors driving poor PCMHC and disparities in PCMHC. Health provider stress and unconscious bias are important to consider because: (1) providers in low-resource settings often work under very stressful conditions; (2) unconscious bias is prevalent in every society including SSA; and (3) these factors are mutually reinforcing drivers of poor quality care and disparities in person-centered care. To prepare me to develop my unique research program and extend the evidence base on interventions to improve PCMHC, I propose training and research during the mentored phase (K99) to extend my knowledge and skills in: (1) stress and unconscious bias; (2) advanced qualitative and mixed methods research; and (3) implementation science methodology. In the K99 phase, I will also conduct (1) multilevel secondary data analysis to examine individual level characteristics and potential system level stressors associated with PCMHC, focusing on the role of provider stress; and (2) structured and in-depth interviews with providers to examine the levels of provider stress and unconscious bias, and the types of stressors and biases in Kenya. The knowledge and skills gained in the mentored phase, as well as the results of the mentored research, will be instrumental to achieving the aims of the independent phase (R00), which are to: (1) design a multicomponent theory and evidence-based intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on: (a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider stress levels—using a pretest-posttest control group design. I will use the results of the pilot to refine the intervention and develop an R01 proposal for a multi-site evaluation with a larger sample and longer follow up, to assess impact on PCMHC. My mentorship and consulting team is uniquely poised to assist me in achieving my training and research goals, and to ensure my successful transition to an independent investigator.

项目摘要/摘要这项获得独立奖的途径（K99/R00）将有助于我向独立科学家的过渡对孕产妇和儿童健康的社会，结构和卫生系统驱动因素进行创新研究。（MCH）差异，并翻译发现的干预措施，以减少差异和改善MCH的成果。压力和无意识的偏见，以改善孕产妇医疗保健，尤其是以人为中心的尺寸贫穷的以人为中心的孕妇医疗保健（PCMHC）撒哈拉以南非洲（SSA）的死亡率以及PCMHC的差异是使用母体的差异但是，关于如何改善PCMHC并减少差异的研究很少。这个项目的差距。驱动PCMHC不良的因素和PCMHC的分配。重要的是要考虑：（1）低资源环境中的提供商通常在非常压力下工作条件；（2）在包括SSA的每个社会中都普遍存在；（3）这些因素是相互的以人为中心的护理和以人为中心的差异来加强差异。我建议独特的研究计划，并扩大有关改善PCMHC的干预措施的证据。在指导阶段（K99）的培训和研究，以扩展我的知识和技能：（1）压力和无意识的偏见；（2）高级定性和混合方法；方法论。水平特征和潜在的系统水平，并与PCMHC压力，重点是提供者的压力和（2）与提供者的结构性和深入的访谈压力和无意识的偏见，以及肯尼亚的压力源和偏见的类型。在指导阶段，作为指导研究的结果，将有助于实现它独立阶段（R00）的目的，该阶段是：（1）设计多组分理论和基于证据的理论使提供者能够识别和管理不符合的偏见的干预措施；评估的干预措施是盛宴；（a）提供者的知识，态度和行为与压力和毫无疑问的偏见有关；应力水平使用预测试对照组设计。间隔并开发R01建议，以进行多站点评估，并进行更大的样本，并且随访更长，评估对PCMHC的影响。我的培训和研究目标，并确保我成功地过渡到独立研究者。