Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Johns Hopkins Center for Health Equity, Baltimore, MD 21287, USA.
Int J Environ Res Public Health. 2023 Jul 3;20(13):6283. doi: 10.3390/ijerph20136283.
The objective of this study is to explore the cultural, social, and historical factors that affect postpartum primary care utilization among Black women with cardiometabolic risk factors and to identify the needs, barriers, and facilitators that are associated with it. We conducted in-depth interviews of 18 Black women with one or more cardiometabolic complications (pre-pregnancy chronic hypertension, diabetes, obesity, preeclampsia, or gestational diabetes) within one year of delivery. We recruited women from three early home-visiting programs in Baltimore, Maryland, between May 2020 and June 2021. We used Critical Race Feminism theory and a behavioral model for healthcare utilization as an analytical lens to develop a codebook and code interview transcripts. We identified and summarized emergent patterns and themes using textual and thematic analysis. We categorized our findings into six main themes: (1) The enduring influence of structural racism, (2) personally mediated racism in healthcare and beyond, (3) sociocultural beliefs about preventative healthcare, (4) barriers to postpartum care transitions, such as education and multidisciplinary communication, (5) facilitators of postpartum care transitions, such as patient-provider relationships and continuity of care, and (6) postpartum health and healthcare needs, such as mental health and social support. Critical race feminism provides a valuable lens for exploring drivers of postpartum primary care utilization while considering the intersectional experiences of Black women.
本研究旨在探讨影响具有心血管代谢危险因素的黑人女性产后初级保健利用的文化、社会和历史因素，并确定与之相关的需求、障碍和促进因素。我们对 18 名在分娩后一年内患有一种或多种心血管代谢并发症（妊娠前慢性高血压、糖尿病、肥胖、先兆子痫或妊娠期糖尿病）的黑人女性进行了深入访谈。我们于 2020 年 5 月至 2021 年 6 月期间在马里兰州巴尔的摩的三个早期家访计划中招募了这些女性。我们使用批判种族女权主义理论和医疗保健利用行为模型作为分析视角，制定了一个代码本并对访谈记录进行了编码。我们使用文本和主题分析方法，确定并总结了新出现的模式和主题。我们将研究结果分为六个主要主题：（1）结构性种族主义的持久影响，（2）医疗保健及其他领域中个人介导的种族主义，（3）关于预防保健的社会文化信念，（4）产后护理过渡的障碍，如教育和多学科沟通，（5）产后护理过渡的促进因素，如医患关系和连续性护理，（6）产后健康和医疗保健需求，如心理健康和社会支持。批判种族女权主义为探索黑人女性的交叉体验如何影响产后初级保健的利用提供了一个有价值的视角。
