Quinn Katherine G, Marion Erica, Williams Joni S, Blackwell Dalvery, Olson Jessica, Palatnik Anna
Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, USA.
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, USA.
J Racial Ethn Health Disparities. 2025 Apr 16. doi: 10.1007/s40615-025-02444-3.
There are significant racial disparities in maternal health and birth outcomes in the USA that disproportionately affect Black individuals. Incorporating community-based doula programs into hospital settings may be an effective intervention to reduce these disparities. However, little research has examined potential barriers and identified strategies to optimize the implementation of a community-based doula program in an academic hospital setting. This study used in-depth interviews with clinicians and nurses (n = 19) and focus groups with doulas (n = 11) to identify multi-level barriers to implementing a doula program for Black pregnant patients in a single academic hospital setting in Milwaukee, WI. Data were analyzed using thematic analysis, and we developed four themes that highlight potential implementation barriers: (1) doulas' advocacy efforts were met with resistance from the healthcare team; (2) there was a lack of trust and established relationships between doulas, clinicians, and nurses; (3) there was a hierarchy of knowledge within medical settings that diminished the value of doulas' expertise; and (4) system-level barriers prevented sustained integration of doula programs. Despite the promise of community-based doula programs, significant investment and resources are needed to support implementation and ensure sustainability.
在美国，孕产妇健康和分娩结局存在显著的种族差异，黑人受到的影响尤为严重。将基于社区的导乐计划纳入医院环境可能是减少这些差异的有效干预措施。然而，很少有研究探讨潜在障碍并确定在学术医院环境中优化基于社区的导乐计划实施的策略。本研究通过对临床医生和护士（n = 19）进行深入访谈以及对导乐（n = 11）进行焦点小组讨论，以确定在威斯康星州密尔沃基市一家学术医院为黑人孕妇实施导乐计划的多层次障碍。使用主题分析法对数据进行分析，我们确定了四个突出潜在实施障碍的主题：（1）导乐的宣传努力遭到医疗团队的抵制；（2）导乐、临床医生和护士之间缺乏信任和既定关系；（3）医疗环境中存在知识等级制度，降低了导乐专业知识的价值；（4）系统层面的障碍阻碍了导乐计划的持续整合。尽管基于社区的导乐计划前景广阔，但仍需要大量投资和资源来支持实施并确保其可持续性。
