Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

Katherine I Tierney, Ellen Wagenfeld-Heintz, Cynthia Bane, Silvia Linares, Megan Sandberg, Drew Moss, Abby Duerst, Claudia Walters, Terra Bautista, Lynette Gumbleton, Catherine L Kothari
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Abstract

Introduction: In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women.

Methods: The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34).

Results: In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P = .001; SES: b, 2.18; SE, 0.60; P < .001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P < .001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P < .001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9).

Discussion: Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.

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围产期妇女中的社会歧视、警惕性和患者与医疗服务提供者的关系:混合方法研究。
导言:在美国,孕产妇死亡率居高不下,并且因种族和社会经济地位(SES)而异。患者-医护人员关系和社会歧视分别与孕产妇不良预后有关,但这些机制如何相互关联尚不清楚。因此,本研究调查了社会歧视经历如何与围产期妇女中的患者-医护人员关系质量相关联并在患者-医护人员关系质量中体现出来:本研究采用混合方法设计,采用解释-序列方法。首先,利用结构方程模型对密歇根州卡拉马祖县的 244 名围产期妇女进行了横截面代表性调查,并进行了路径分析。其次,对调查参与者组成的焦点小组(n = 34)进行了专题定性分析:结果:在定量分析中,种族和社会经济地位与社会歧视经历的相关性符合预期(种族:b,1.87;SE,0.58;P = .001;社会经济地位:b,2.18;SE,0.60;P 讨论):总体而言,定量分析支持概念模型,即种族和社会经济地位与社会歧视相关,而社会歧视与警觉行为相关,进而与患者-医患关系的质量相关。定性分析为这些途径如何在护理环境中体现提供了初步证据,并证明了在患者-提供者关系中建立信任的重要性,尤其是在有色人种女性中。
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