Southern California Permanente Medical Group, Department of Neonatal-Perinatal Medicine, Kaiser Permanente Riverside Medical Center, 10800 Magnolia Ave, Riverside, CA, 92505, USA.
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
Matern Child Health J. 2024 Jul;28(7):1198-1209. doi: 10.1007/s10995-024-03896-5. Epub 2024 Jan 31.
Addressing persistent racial inequities in preterm birth requires innovative health care approaches. The Los Angeles County Maternity Assessment and Management Access Service Synergy Neighborhood program (MAMA's) is a perinatal medical home program designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates in Black participants, yet it is unclear which program components most contributed to this reduction. This study seeks to understand the experiences of staff and clients within the MAMA's program to identify what factors decrease stress, how the program addresses racism and the challenges and opportunities of optimizing health during the COVID-19 pandemic.
21 staff and 34 clients completed semi-structured interviews from November 2020-December 2021. Separate interview guides for staff and clients explored experiences within the program, experiences during the COVID-19 pandemic, and how racism affects clients. Interviews were recorded and transcribed. Analysis used a phenomenologic framework. Coding was performed using grounded theory to identify themes.
Analysis revealed six key themes: Stressors clients face, barriers for undocumented, Latina, and Spanish-speaking clients, exceptional care, emotional support, naming and responding to racism and discrimination, and impacts of COVID-19 pandemic.
Staff and clients work together to address social needs in order to address chronic stress and racism in their lives, especially during the COVID-19 pandemic. Interviews revealed relationship building is a cornerstone of the program's success and plays a significant role in alleviating chronic stress in this population.
要解决早产方面持续存在的种族不平等问题，需要创新的医疗保健方法。洛杉矶县产妇评估和管理准入服务协同社区项目（MAMA's）是一个围产期医疗保健之家项目，旨在通过解决健康的社会决定因素来减轻慢性压力的影响。该项目降低了黑人参与者的早产率，但尚不清楚哪些项目内容对降低早产率的贡献最大。本研究旨在了解 MAMA's 项目中的员工和客户的体验，以确定哪些因素可以减轻压力，该项目如何解决种族主义问题，以及在 COVID-19 大流行期间优化健康的挑战和机遇。
2020 年 11 月至 2021 年 12 月期间，21 名员工和 34 名客户完成了半结构化访谈。员工和客户的单独访谈指南探讨了项目内的经验、COVID-19 大流行期间的经验，以及种族主义如何影响客户。访谈进行了录音和转录。分析使用现象学框架。使用扎根理论进行编码以确定主题。
分析显示了六个关键主题：客户面临的压力源、无证、拉丁裔和西班牙语客户面临的障碍、特殊护理、情感支持、命名和应对种族主义和歧视，以及 COVID-19 大流行的影响。
员工和客户共同努力解决社会需求，以解决他们生活中的慢性压力和种族主义问题，特别是在 COVID-19 大流行期间。访谈显示，建立关系是该项目成功的基石，并在缓解该人群的慢性压力方面发挥了重要作用。
