BACKGROUND: Haitian women in Massachusetts experience higher than average rates of low birth weight, C-section and inadequate prenatal care. Given the disparities in Black maternal health in the U.S., creative and innovative care models are necessary to improve outcomes. Culturally specific care models have been found to improve satisfaction and uptake of prenatal care among immigrants. A mixed methods case study was conducted at Boston Medical Center with the aims of describing maternal health outcomes of Haitian women, understanding Haitian women’s experiences and barriers to care and the feasibility of culturally specific maternity care models.
METHODS: Electronic medical records were used to obtain and analyze retrospective data about patients’ socio-economic factors, baseline health maternity characteristics, maternity care utilization characteristics, perinatal complications and obstetrical outcomes stratified by ethnicity from 2015-2019. Chi square analysis was performed to measure statistical significance. Four focus groups and three in-depth interviews were performed with Haitian pregnant and postpartum women (n=25). Key informant interviews (n=14) were conducted with hospital clinical providers and clinical program directors. The 3 delays model, respectful maternal care and cultural competence frameworks were applied, using Nvivo for coding and organizing emerging themes.
RESULTS: Haitian women demonstrate significantly higher than average proportions of advanced maternal age {40.9 %; (<.001)}, obesity {43.8.8%; (<.001)}; delayed entry to prenatal care {49.5; (.007)}; and pre-eclampsia {7.0%; (.001)}. Inadequate access to insurance and transportation contributed to delays in accessing care. Disrespectful and poor coordination of care negatively affected Haitian women’s experience and perceived quality of care. Haitian women desired culturally competent, personalized heath care services. Barriers to cultural competence and the development of culturally specific care models include lack of staff diversity, finances, health care structural design and lack of training.
CONCLUSION: Haitian women may benefit from additional social resources and culturally specific, tailored health programs such as group prenatal care. Recommendations to improve cultural competence include diversifying the workforce, collecting data on racial and ethnic disparities, and trainings to integrate culturally competent principles into clinical practice. Additional research needs include design, implementation and evaluation of culturally specific tailored maternal health interventions with the Haitian population.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/42585 |
| Date | 15 May 2021 |
| Creators | Crevecoeur, Thamarah |
| Contributors | Declercq, Eugene R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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