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：
10227808
负责人：
Patience A Afulani
金额：
$ 24.4万
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/10227808
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 acceptability and feasibility behavior change career design disability disparity reduction effective intervention evidence base experience follow-up health care disparity health disparity implementation process implementation science improved innovation intervention effect low and middle-income countries maternal morbidity multi-component intervention neonatal outcome person centered preference pregnancy related death programs provider factors 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母校和儿童健康的社会，结构和卫生系统驱动力进行创新研究（MCH）差异，并将发现转化为实际干预措施，以减少差异和改善MCH结果。本提案中描述的活动旨在解决医疗保健提供者压力和无意识的偏见以提高物物医疗保健的质量，尤其是以人为中心的方面。以人为中心的材料医疗保健（PCMHC）有助于高母校和新生儿撒哈拉以南非洲（SSA）的死亡率以及PCMHC的差异正在推动使用母体的差异卫生服务。但是，很少有关于如何改善PCMHC和减少分布的研究。我试图填补这个项目的差距。我建议针对健康提供者的压力和无意识的偏见作为基本驱动PCMHC不良的因素和PCMHC的差异。健康提供者的压力和无意识的偏见是重要的是要考虑：（1）低资源环境中的提供商通常在非常压力下工作状况; （2）在包括SSA在内的每个社会中，无意识的偏见都是普遍存在的；（3）这些因素是相互的加强以人为中心的护理质量护理和差异差的驱动因素。为我做好准备发展我提出了独特的研究计划，并扩展了改善PCMHC的干预措施的证据基础。修改阶段（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研究；（3）实施科学方法论。在K99阶段，我还将进行（1）多级辅助数据分析以检查个体水平特征和与PCMHC相关的潜在系统水平压力源，重点是提供者的压力；（2）与提供商的结构化和深入的访谈以检查提供商的水平压力和无意识的偏见，以及肯尼亚的压力源和偏见的类型。获得的知识和技能在修改阶段以及修改研究的结果中，将有助于实现独立阶段（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其压力和无意识偏见的干预措施；（2）飞行员干预以评估其可行性和可接受性；（3）干预措施的评估初步影响：（a）提供者的知识，吸引力和与压力和无意识偏见有关的行为；（b）提供商应力水平 - 使用预测试对照组设计。我将使用飞行员的结果来完善干预和开发R01建议，以进行更大样本的多站点评估，并更长的随访，评估对PCMHC的影响。我的精神制和咨询团队被中毒以帮助我实现我的培训和研究目标，并确保我成功地过渡到独立研究者。