Black Women’s Perspectives of Respectful Maternal Healthcare in Georgia: A Qualitative Exploration of Facilitators and Barriers Open Access
Nicholas, Joy (Spring 2022)
Abstract
Background: In the United States, rates of maternal mortality and morbidity have been steadily increasing. Georgia is one of the states with the highest rates of adverse maternal health outcomes in the U.S., which disproportionately affects racial and ethnic minority women.
Objective: The goal of this study is to understand the barriers and facilitators to maternal health care seeking among Black women in Atlanta, Georgia. This paper also aims to provide Black women-led recommendations for improving respectful care in healthcare settings, which could be used to inform future interventions addressing racial disparities in maternal health.
Methods: This exploratory qualitative study used a community-based participatory research approach to collaboratively develop the study design and collect data with the Center for Black Women’s Wellness (CBWW). The research team conducted four focus group discussions over Zoom among Black women who were enrolled in the Atlanta ECHO cohort study and delivered their child at either Emory Midtown Hospital or Grady Memorial Hospital. A member of the research team conducted a thematic analysis of the focus group data using MAXQDA data analysis software.
Results: Participants identified numerous barriers and facilitators to maternal health care seeking that fell into three categories: quality of interpersonal relationship and communication, adequacy of service, and sociocultural factors. Participants also offered recommendations that were grouped into three categories: quality of interpersonal relationship and communication, quality of service, and a culture of respect.
Discussion: Most of the barriers, facilitators, and recommendations provided by Black women in our study were related to provider and health system level factors while others were linked to more social and cultural influences. This study recommends more training on implicit bias, communication, and interpersonal skills among providers to improve Black women’s perinatal health experiences and quality of care. Additionally, respectful maternity care should be promoted on the provider and health system level to help address maternal health inequities.
Table of Contents
Table of Contents
CHAPTER 1: LITERATURE REVIEW
Definition and Measures of Maternal Mortality
Definition and Measures of Maternal Morbidity
Trends in Maternal Mortality
Global Trends in Maternal Mortality
National Trends and Patterns in Maternal Mortality
Medical Causes of Maternal Mortality
Non-Medical Causes of Maternal Mortality
Trends in Maternal Morbidity
Global Trends in Maternal Morbidity
National Trends in Maternal Morbidity
Medical Causes of Maternal Morbidity
Maternal Morbidity and Mortality in Georgia
Factors Contributing to Adverse Maternal Health Outcomes
Patient-Level Factors
Rise in Chronic Conditions
Advanced Age and Cesarean Deliveries
Substance Use and Mental Health Conditions
Socioeconomic Status and Receipt of Prenatal Care
Social Determinants in General
Provider Level Factors
Implicit Bias
Discrimination and Racism
Patient-provider communication
Healthcare system Level Factors
Quality of Care
Discrimination based on insurance status
Medicaid Expansion
Crisis Pregnancy Centers
Rural disparities
Societal Level Factors
Weathering and Stress
Mistrust of Health Care System
Structural Racism
Adverse Maternal Health Outcomes in Georgia
A Call to Action for Respectful Maternal Health Care
CHAPTER 2: METHODS
Study Design
Study Participants
Data Collection
Data Analysis
Ethical Considerations
CHAPTER 3: RESULTS
Participant characteristics
Description of Topics
Barriers to Seeking and Accessing Maternal Healthcare
Theme 1: Poor interpersonal relationships and communication with medical providers was a major barrier for Black women seeking and utilizing perinatal health care services.
Sub-theme 1: Poor patient-provider communication with maternity care providers was a significant barrier for Black women seeking future perinatal health care services.
Sub-theme 2: Providers’ negative personality characteristics served as a barrier for future maternal healthcare-seeking behaviors among Black women.
Sub-theme 3: The lack of an interpersonal relationship with maternity care providers negatively impacts the perceived quality of care and can serve as a deterrent for Black women seeking maternal healthcare.
Theme 2: Perceived inadequate medical care was another major deterrent for Black women seeking and continuing maternal health services throughout the perinatal period.
Sub-theme 1: The perceived unequal treatment to women enrolled in Medicaid is a major barrier for Black women seeking maternal health services.
Sub-theme 2: Structural barriers, such as lengthy waiting room times and difficulties scheduling appointments, were significant deterrents to Black women seeking maternal healthcare.
Sub-theme 3: Perceived poor quality of clinical care, which includes providers’ failing to meet professional standards of care and medical errors, was another significant barrier to maternal healthcare seeking for Black women.
Theme 3: A range of sociocultural factors was reported to inhibit Black women from seeking and accessing maternal health services.
Sub-theme 1: Psychosocial stress was a significant barrier to Black women seeking maternal health services, especially mental health care, during the perinatal period.
Sub-theme 2: Social and cultural barriers were significant deterrents to maternal health care seeking, including mental health care during the perinatal period, among Black women.
Sub-theme 3: Lacking social support from family and maternity care providers was a major barrier to maternal health care seeking among Black women.
Facilitators to Seeking Maternal Healthcare
Theme 1: Strong interpersonal relationships and communication with providers were key facilitators for Black women seeking and accessing maternal health services.
Sub-theme 1: Good patient-provider communication facilitates greater patient satisfaction, which supports maternal health care seeking among Black women during the perinatal period.
Sub-theme 2: Providers’ positive personality characteristics such as being nice and supportive served as a facilitator for future maternal healthcare-seeking behaviors among Black women.
Sub-theme 3: A strong interpersonal relationship with a provider is another facilitator to maternal healthcare seeking among Black women.
Theme 2: Perceived quality of care was another facilitator for Black women seeking and continuing to utilize maternal health services during the perinatal period.
Sub-theme 1: When maternal health services are perceived as convenient or easy to access, it facilitates maternal health seeking among Black women.
Sub-theme 2: Perceived high-quality medical care, which includes care that either meets medical standards or more holistic care that ensures all their needs are met, is a key facilitator to maternal healthcare seeking among Black women.
Theme 3: Certain social and cultural factors, such as racial or gender concordance between patient and providers and social support, helped facilitate Black women’s maternal health care seeking behaviors.
Sub-theme 1: Perceptions of a shared identity between providers and their patients is a major facilitator to maternal healthcare seeking among Black women.
Sub-theme 2: Social support from family, providers, and technology was another key facilitator to maternal healthcare seeking among Black women.
Recommendations
Theme 1: It is recommended that the quality of interpersonal relationships and communication with perinatal health providers improves in order to ensure respectful maternity care.
Sub-theme 1: To ensure respectful maternal care, it is recommended that patient-provider communication between Black women and their maternity care provider improves.
Sub-theme 2: It is recommended that maternity care providers’ should have favorable personality qualities such as compassion, and practice esteemed approaches to care including more personalized care to ensure respectful care.
Sub-theme 3: It is recommended that Black women are offered more social support to ensure respectful maternity care.
Theme 2: It is recommended that the quality of perinatal health services improves to ensure respectful maternity care.
Theme 3: It is recommended that respectful maternity care is promoted at both the provider and health system level.
Sub-theme 1: It is recommended that providers show their patients more respect and maintain their patients’ autonomy in order to ensure respectful care.
Sub-theme 2: It is recommended that community-based approaches, such as doula care and culturally acceptable alternative sources of care, are more accessible to Black women to ensure the provision of respectful care.
Sub-theme 3: It is recommended that Black women prioritize self-care, which promotes advocacy that is essential for ensuring respectful maternity care.
CHAPTER 4: DISCUSSION
Barriers
Provider level factors
Service and Health System Level Factors
Community/Societal Level Factors
Facilitators
Provider level factors
Health system level factors
Recommendations
Strengths and Limitations
CHAPTER 5: PUBLIC HEALTH IMPLICATIONS
Works Cited
About this Master's Thesis
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