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Nell J, Jackson K, Andipatin M. The lived experience of South African men having a premature baby. Health SA 2024; 29:2522. [PMID: 38726064 PMCID: PMC11079363 DOI: 10.4102/hsag.v29i0.2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background Much has been written about fathers, fatherhood and premature babies. However, in the South African context, studies about the experiences of fathers having a premature baby are lacking. Aim This study aimed to explore how South African fathers (n = 10) experience having a premature baby using a descriptive phenomenological approach. Setting This research study was conducted online using various social media platforms such as WhatsApp, Google Meet and through telephonic conversations. Methods A descriptive phenomenological approach that allowed for the distillation and elucidation of common core experiences among fathers who had a premature baby. Results The findings demonstrated that the participants experienced intense fears regarding the survival and well-being of their children. They reported experiencing financial difficulties related to hospital bills and experienced being alienated by hospital institutions. Despite these reported barriers, these fathers were adamant in their resolve to support their children and partners during this challenging time. Conclusion The experiences of fathers were riddled with fear, uncertainty, ambiguity and alienation, which placed them in very precarious situations when trying to navigate their role in a more sensitive and enlightened way. Having a premature infant calls into question the systems that men are positioned within as these systems to a large extent shape these events and how they are experienced. Contribution This study is original as no other published studies seem to exist in South Africa that speaks to fathers' lived experiences of having a premature baby.
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Affiliation(s)
- Jonathan Nell
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Kyle Jackson
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Michelle Andipatin
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Vance AJ, Farmer ML, D'Agata A, Moore T, Esser M, Fortney CA. NANN Membership Recommendations: Opportunities to Advance Racial Equity Within the Organization. Adv Neonatal Care 2024; 24:71-77. [PMID: 37703135 DOI: 10.1097/anc.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Neonatal care has advanced significantly in recent years, yet racial health inequities persist in the neonatal intensive care unit (NICU), with infants from racial and ethnic minority groups less likely to receive recommended treatment. Healthcare providers acknowledge that there are steps that can be taken to increase knowledge and awareness regarding health inequities. PURPOSE To better understand current health equity-related initiatives in the neonatal community and solicit feedback from National Association of Neonatal Nurses (NANN) membership about advancing racial equity within the organization. METHODS A cross-sectional survey was conducted in January 2021. The anonymous, onetime survey was distributed to active NANN members via SurveyMonkey and included questions related to racial equity initiatives, recommendations, and demographics. Data analysis was conducted using an exploratory approach using descriptive statistics, and thematic analysis was used to summarize responses to open-ended questions. RESULTS There were 325 members who completed the full survey, of whom were White (83%), female (96%), staff nurses (42%), and those with more than 16 years of experience (69%), and most (69%) were familiar with NANN's racial equity position statement. Recommendations were summarized into the following themes: (1) research, (2) education, (3) workforce diversity, (4) communication, (5) scholarships, (6) resources, and (7) community outreach. IMPLICATIONS FOR PRACTICE AND RESEARCH NANN members offered clear and actionable recommendations to advance health equity within the neonatal community and organization, which included offering more diversity, inclusion, and equity education at the annual conferences, in ANC articles, and newsletters, and the creation of scholarships or reduced membership fees to encourage diverse enrollment in the organization.
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Affiliation(s)
- Ashlee J Vance
- Henry Ford Health, Detroit, Michigan (Dr Vance); Marietta Neonatology, Marietta, Georgia (Dr Farmer); The Univeristy of Rhode Island College of Nursing, Kingston, Rhode Island (Dr D'Agata); Univeristy of Nebraska Medical Center College of Nursing, Omaha, Nebraska (Dr Moore); Alverno College School of Nursing and Health Professions, Milwaukee, Wisconsin (Dr Esser); and The Ohio State University College of Nursing, Columbus, Ohio (Dr Fortney)
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Smith C, Pitter C, Udoudo DA. Fathers' Experiences during Delivery of Their Newborns: A Content Analysis. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2024; 12:23-31. [PMID: 38328009 PMCID: PMC10844877 DOI: 10.30476/ijcbnm.2023.100009.2337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
Background Paternal involvement during pregnancy has been shown to have a positive impact on the mother-baby dyad during and after birth. The presence of the father during birth also positively influences father-child attachment, reduces, apprehension, and stress, increases maternal satisfaction, and increases love and respect for the partners. This study explored the experiences of fathers who were present in the delivery room during the delivery process. Methods This qualitative content analysis study was conducted at a maternity hospital in Kingston, Jamaica from June to July 2022. A total of ten (10) fathers of babies delivered within six weeks were purposefully selected to be interviewed via telephone over four weeks. Data were analysed using a thematic approach. Results Four sub-themes and one theme were extracted from data analysis. Fathers perceived satisfaction and empowerment in the shadow of positive and negative feelings as the theme. Sub-themes emerged from the data including "clinician's acceptance and support", "close bonding and attachment with mother and baby", "preparedness of fathers to give support", and "inspiring and amazing feeling by fatherhood experiences". Conclusion Fathers experienced the feeling of empowerment and wished to take up their role during the delivery of their newborns. Their experiences were influenced by the midwives and the resources available to support their accommodation. More policies are needed to strengthen the fathers' involvement during antenatal clinic visits, delivery, and postnatal care.
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Affiliation(s)
| | - Cynthia Pitter
- The UWI School of Nursing, Mona, Faculty of Medical Sciences, University of the West Indies at Mona, Kingston, Jamaica
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Bresnahan M, Zhuang J, Elam K, Goldbort J, Shareef S, Bogdan-Lovis E. Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S. HEALTH COMMUNICATION 2023:1-9. [PMID: 37580862 DOI: 10.1080/10410236.2023.2247607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.
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Affiliation(s)
| | - Jie Zhuang
- Department of Communication Studies, Texas Christian University
| | - Kendra Elam
- College of Nursing, Michigan State University
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Bagambe PG, Nyirazinyoye L, Floyd Cechetto D, Luginaah I. Perceptions of male partners on maternal near-miss events experienced by their female partners in Rwanda. PLoS One 2023; 18:e0286702. [PMID: 37294814 PMCID: PMC10256223 DOI: 10.1371/journal.pone.0286702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/22/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Maternal near-miss refers to women who survive death from life-threatening obstetric complications and has various social, financial, physical, and psychological impacts on families. OBJECTIVE To explore male partners' perceptions of maternal near-miss experienced by their female partners and the associated psychosocial impacts on their families in Rwanda. METHODS This was a qualitative study involving 27 semi-structured in-depth interviews with male partners whose spouses experienced a maternal near-miss event. Data were analyzed using a thematic coding to generate themes from participants' responses. RESULTS Six key themes that emerged were: male partner's support during wife's pregnancy and during maternal near-miss hospitalization, getting the initial information about the spouse's near-miss event, psychosocial impacts of spouse's near-miss, socio-economic impact of spouse's near-miss, post- maternal near-miss family dynamics, and perceived strategies to minimize the impacts of near-miss. Male partners reported emotional, social, and economic impacts as a result of their traumatic experiences. CONCLUSIONS The impact of maternal near-miss among families in Rwanda remains an area that needs healthcare attention. The residual emotional, financial, and social consequences not only affect females, but also their male partners and their relatives. Male partners should be involved and be well-informed about their partners' conditions and the expected long-term effects of near-miss. Also, medical and psychological follow-up for both spouses is necessary for the enhancement of the health and well-being of affected households.
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Affiliation(s)
- Patrick Gatsinzi Bagambe
- Department of Obstetrics and Gynecology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - David Floyd Cechetto
- Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Ontario, Canada
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Boni L, Gradellini C, Miari M, Cocconi P, Montorsi A, Capone R, Costi S, Di Leo S, Puglisi C, Ghirotto L. How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study. J Pediatr Nurs 2022; 67:e172-e179. [PMID: 35987669 DOI: 10.1016/j.pedn.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. DESIGN AND METHODS We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. RESULTS On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. CONCLUSIONS Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. PRACTICE IMPLICATIONS Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.
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Affiliation(s)
- Laura Boni
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, via Giovanni Amendola 2, 42122 Reggio Emilia, Italy
| | - Cinzia Gradellini
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; Nursing Course, University of Modena and Reggio Emilia, Italy.
| | - Monica Miari
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Annalisa Montorsi
- Ospedale Sassuolo SpA, via Francesco Ruini 2, 41049 Sassuolo, Modena, Italy
| | - Roberto Capone
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefania Costi
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Silvia Di Leo
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Chiara Puglisi
- Reserach Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Luca Ghirotto
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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de la Rocha P, Sudhinaraset M, Jones NV, Kim C, Cabral A, Amani B. A Qualitative Analysis on Sexual and Reproductive Health Needs and Issues During COVID-19 Using a Reproductive Justice Framework. Ethn Dis 2022; 32:357-372. [PMID: 36388866 PMCID: PMC9590595 DOI: 10.18865/ed.32.4.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The COVID-19 pandemic exacerbated existing health inequities, further exposing the challenges in meeting the sexual and reproductive health (SRH) needs, particularly for Black, Indigenous and People of Color (BIPOC). We interviewed 11 key informants through three focus groups to explore barriers and pathways to SRH care for BIPOC during COVID-19 in the United States. Reimagining reproductive health practices requires holistic practices and multisector pathways, a comprehensive reproductive justice approach. This includes interventions across the sexual and reproductive health continuum. Using a deductive-dominant approach grounded in reproductive justice values, we explore themes around SRH during COVID-19. Five themes for advancing reproductive justice were identified: "supremacy of birth"; police violence as a determinant of SR mental health; addressing quality of care outside of hospital settings; digital redlining; and centering joy, liberation, and humanity.
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Affiliation(s)
- Patanjali de la Rocha
- Department of Global Health, University of Washington, Seattle, WA, Address correspondence to Patanjali de la Rocha MSW, MPH; Charles Drew University & UCLA COVID-19 Task Force on Racism and Equity;
| | - May Sudhinaraset
- Fielding School of Public Health, University of California, Los Angeles, CA
| | - Nicole V. Jones
- Fielding School of Public Health, University of California, Los Angeles, CA
| | - Catherine Kim
- Fielding School of Public Health, University of California, Los Angeles, CA
| | - Alejandra Cabral
- Fielding School of Public Health, University of California, Los Angeles, CA
| | - Bita Amani
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
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White VanGompel E, Lai J, Davis D, Carlock F, Camara TL, Taylor B, Clary C, McCorkle‐Jamieson AM, McKenzie‐Sampson S, Gay C, Armijo A, Lapeyrolerie L, Singh L, Scott KA. Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite). Birth 2022; 49:514-525. [PMID: 35301757 PMCID: PMC9544169 DOI: 10.1111/birt.12622] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
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Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and GynecologyPritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA,NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | - Jin‐Shei Lai
- Departments of Medical Social Sciences and PediatricsNorthwestern University Feinberg School of MedicineEvanstonIllinoisUSA
| | - Dána‐Ain Davis
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | | | - Brianne Taylor
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Chakiya Clary
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ashlee M. McCorkle‐Jamieson
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Department of Obstetrics and GynecologyHighland General HospitalAlameda Health SystemOaklandCaliforniaUSA
| | - Safyer McKenzie‐Sampson
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology & BiostatisticsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Caryl Gay
- Department of Family Health Care NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amanda Armijo
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lillie Lapeyrolerie
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lavisha Singh
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Karen A. Scott
- Birthing Cultural Rigor, LLCOaklandCaliforniaUSA,Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Humanities and Social SciencesUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Tucker Edmonds B, Schmidt A, Walker VP. Addressing bias and disparities in periviable counseling and care. Semin Perinatol 2022; 46:151524. [PMID: 34836664 DOI: 10.1016/j.semperi.2021.151524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Addressing bias and disparities in counseling and care requires that we contend with dehumanizing attitudes, stereotypes, and beliefs that our society and profession holds towards people of color, broadly, and Black birthing people in particular. It also necessitates an accounting of the historically informed, racist ideologies that shape present-day implicit biases. These biases operate in a distinctly complex and damaging manner in the context of end-of-life care, which centers around questions related to human pain, suffering, and value. Therefore, this paper aims to trace biases and disparities that operate in periviable care, where end-of-life decisions are made at the very beginning of life. We start from a historical context to situate racist ideologies into present day stereotypes and tropes that dehumanize and disadvantage Black birthing people and Black neonates in perinatal care. Here, we review the literature, address historical incidents and consider their impact on our ability to deliver patient-centered periviable care.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Associate Professor of Obstetrics and Gynecology & Vice Chair for Faculty Development and Diversity, Department of Obstetrics and Gynecology; Assistant Dean for Diversity Affairs, Indiana University School of Medicine, Indianapolis, IN.
| | | | - Valencia P Walker
- Associate Chief Diversity & Health Equity Officer, Nationwide Children's Hospital; Associate Division Chief for Health Equity & Inclusion, Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine
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Tesfalul MA, Feuer SK, Castillo E, Coleman-Phox K, O'Leary A, Kuppermann M. Patient and provider perspectives on preterm birth risk assessment and communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2814-2823. [PMID: 33892976 PMCID: PMC9005337 DOI: 10.1016/j.pec.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To describe and compare how obstetric patients and care providers view preterm birth risk assessment and communication. METHODS We conducted eight focus groups with obstetric patients (n = 35) and 16 qualitative interviews with obstetric providers. Grounded theory was used to identify and analyze themes. RESULTS Patients' knowledge about preterm birth varied greatly. Similar benefits and risks of preterm birth risk counseling were discussed by patients and providers with notable exceptions: patients cited preparedness as a benefit and providers cited maternal blame, patient alienation, and estimate uncertainty as potential risks. Most patients expressed a desire to know their personalized preterm birth risk during pregnancy. Providers differed in whether they offer universal versus selective, and quantitative versus qualitative, preterm birth risk counseling. Many providers expressed concern about discussing social and structural risk factors for preterm birth. CONCLUSION While many patients desired knowing their personalized preterm birth risk, prenatal care providers' disclosure practices vary because of uncertainty of estimates, concerns about negative consequences and challenges of addressing systemic inequities and social determinants of health. PRACTICE IMPLICATIONS Given the existing asymmetry of information about preterm birth risk, providers should consider patient preferences regarding and potential benefits and risks of such disclosure in their practice.
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Affiliation(s)
- Martha A Tesfalul
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
| | - Sky K Feuer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Esperanza Castillo
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Allison O'Leary
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
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Research Questions that Matter to Us: priorities of young people with chronic illnesses and their caregivers. Pediatr Res 2021; 89:1659-1663. [PMID: 33069165 DOI: 10.1038/s41390-020-01207-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/08/2022]
Abstract
AIM The rising number of children carrying chronic disease with them into adulthood presents the research community with an obligation to address their unique needs. Authentic involvement of individuals and communities directly affected by the condition being studied ensures that research answers the questions of those most affected. Our aim was to identify the highest priority research questions of young people living with chronic illness and their caregivers. MATERIALS AND METHODS We conducted a qualitative study using the Research Prioritization by Affected Communities (RPAC) method. Participants were recruited from two hospitals and two community organizations to participate in focus groups. RESULTS Twenty three participants developed and prioritized 300 potentially researchable questions. Thematic analysis of the priority research topics revealed three health dimensions of chronic illness (physical health, social-emotional health and navigating the health care system) and two cross-cutting dimensions (living with a chronic illness and future with a chronic illness). CONCLUSION Young people experiencing different chronic conditions were able to achieve consensus on the same set of condition-agnostic research priorities, age and role influenced research priorities. We report these research priorities to inform and influence local and national research agendas and funding priorities. IMPACT Patients and caregivers affected by different chronic illnesses were able to achieve consensus on condition-agnostic research priorities. Age and role influenced research priorities. Questions posed by young people experiencing different chronic conditions fell under three themes (physical, social-emotional and health care system) and two cross-cutting dimensions (living with a chronic illness and future with a chronic illness). Use of the Research Prioritization by Affected Communities (RPAC) method, which begins with the patient's lived experiences, provided nuanced insights into the complexity of living with a chronic illness and surfaced under-studied research topics to guide future research investment.
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Sigurdson K, Profit J, Dhurjati R, Morton C, Scala M, Vernon L, Randolph A, Phan JT, Franck LS. Former NICU Families Describe Gaps in Family-Centered Care. QUALITATIVE HEALTH RESEARCH 2020; 30:1861-1875. [PMID: 32713256 PMCID: PMC8106872 DOI: 10.1177/1049732320932897] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Care and outcomes of infants admitted to neonatal intensive care vary and differences in family-centered care may contribute. The objective of this study was to understand families' experiences of neonatal care within a framework of family-centered care. We conducted focus groups and interviews with 18 family members whose infants were cared for in California neonatal intensive care units (NICUs) using a grounded theory approach and centering the accounts of families of color and/or of low socioeconomic status. Families identified the following challenges that indicated a gap in mutual trust and power sharing: conflict with or lack of knowledge about social work; staff judgment of, or unwillingness to address barriers to family presence at bedside; need for nurse continuity and meaningful relationship with nurses and inconsistent access to translation services. These unmet needs for partnership in care or support were particularly experienced by parents of color or of low socioeconomic status.
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Affiliation(s)
- Krista Sigurdson
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Jochen Profit
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Ravi Dhurjati
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Christine Morton
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Melissa Scala
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Lelis Vernon
- Vermont Oxford Network, Burlington, Vermont, USA
| | | | | | - Linda S. Franck
- School of Nursing, University of California, San Francisco, California, USA
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