Purpose: This study assessed the association between everyday experiences of discrimination and patient-provider relationships, including women’s recommendations for improving their relationships in order to better perinatal care.
Background: Experiencing discrimination can lead to hyper-vigilance in multiple settings and across various types of relationships. Pregnant women of color and low SES are particularly vulnerable. Patient-provider relationships are negatively influenced by discrimination.
Methods: This mixed-methods study combined survey data from a sample of 244 postpartum women, and focus group results from a subset of 57. Quantitative measures included the Everyday Discrimination, Vigilance, and Provider Relationship scales. The twelve focus groups were audio recorded, transcribed, and consensus-coded for themes, which were stratified by level of vigilance, race and SES.
Results: Nearly half (45.9%, n=112) of women reported experiencing discrimination monthly or more often. Women of color and low income reported double the rates of discrimination. Discrimination was significantly related to vigilance (B.428 w/CI .281,.575, p< .001). Vigilance, in turn, significantly detracted from provider relationship (B .214 w/CI .088,.341, p=.001). Major themes associated with high-vigilance were feeling not heard, not trusted and not respected by providers. Women approached these relationships with higher levels of mistrust.
Discussions: When pregnant women experience discrimination in the community, they experience the world with a heightened sense of vigilance, which in turn affects perinatal visits. Given the state of health inequity in perinatal care and the non-white infant mortality rate, this study indicates the need for providers to be respectful of their patients’ prior experiences and be attentive to the patient-provider relationship.
Topics: CREOG & APGO Annual Meeting, 2021, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, GME, CME, Public Health, Advocacy, Maternal-Fetal Medicine,
Megan Sandberg, B.S., Western Michigan Homer Stryker School Medicine; Drew Moss, BS; Claudia Waters, BS; Lynette Gumbleton, BA; Silvia Linares, MD; Megan Deibel, DNP, CNM
