Clinical trial NCT05019131: Caring for Providers to Improve Patient Experience Study Phase 2 in Migori County
Official title: Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Maternal Health
Mental Health
Healthcare Provider
Adverse Outcomes
Stress
Stress, Psychological
Stress, Emotional
Quality of Care
Burnout
Discrimination, Social
Keywords: providers
mental health
unconscious bias
prejudice
Kenya
stress
burnout
person-centered care
quality of care
discrimination
Lead sponsor: University of California, San Francisco
Sponsor class: OTHER
Collaborators: name: Kenya Medical Research Institute
name: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
First posted: 2021-08-24
Enrollment: 83
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The activities described in this proposal are aimed at addressing health care provider stress and unconscious bias to improve quality of maternal health care, particularly related to the person-centered dimensions of care-i.e. care that is respectful and responsive to women's needs, preferences, and values. The investigators focus on health provider stress and unconscious bias because they are key drivers of poor-quality care that are often not addressed in interventions designed to improve quality of maternal health care. The investigators plan to (1) design an intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on: (a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider stress levels.

Detailed description: Poor person-centered maternal health care (PCMHC) contributes to high maternal and neonatal mortality in sub-Saharan Africa (SSA), and disparities in PCMHC are driving disparities in use of maternal health services., However, little research exists on how to improve PCMHC and reduce disparities. The investigators seek to fill this gap with this project. They propose targeting health provider stress and unconscious bias as fundamental factors driving both poor PCMHC and disparities in PCMHC. Health care provider stress and unconscious bias are important to consider because: (1) providers in low-resource settings often work under very stressful conditions; (2) unconscious bias is prevalent in every society including SSA; and (3) these factors are mutually reinforcing drivers of poor quality care and disparities in person-centered care. In the first phase of the project (CPIPE1), they conducted research to examine (1) the factors associated with PCMHC and identified provider stress and unconscious bias as key contributing factors. They also examined the levels of provider stress and unconscious bias and the types of stressors and biases in Migori County, Kenya. The results of that research will be used to inform this phase (CPIPE2), the aims of which are to: (1) design a multicomponent theory and evidence-based intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on: (a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider stress levels using a pretest-posttest control group design. They will use the results of the pilot to refine the intervention and develop an R01 proposal for a multi-site evaluation with a larger sample and longer follow up to assess impact on PCMHC. This study will yield valuable information to inform quality improvement efforts for PCMHC.

Eligibility criteria: Inclusion Criteria:

* Providers working in maternity units of the intervention facilities are all eligible.

Exclusion Criteria:

* Inability to attend scheduled training.

Primary outcomes:
measure: Change in Perceived Stress Scale (PSS) Score From Baseline to 6 Months
timeFrame: Baseline and 6 months
measure: Change in Shirom-Melamed Burnout Measure (SMBM) Score From Baseline to 6 Months
timeFrame: Baseline and 6 months
measure: Change in Stress Knowledge and Attitudes Score From Baseline to 6 Months
timeFrame: Baseline and 6 months
measure: Change in Unconscious Bias Knowledge and Attitudes Score From Baseline to 6 Months
timeFrame: Baseline and 6 months
Secondary outcomes:
measure: Change in Hair Cortisol Levels From Baseline to 6 Months
timeFrame: Baseline and 6 months
measure: Change in Heart Rate Variability (HRV) Levels From Baseline to 6 Months
timeFrame: Baseline and 6 months
measure: Change in Socioeconomic Status-person Centered Maternity Care Implicit Association Test (IAT) Score
timeFrame: Baseline and 6 months
measure: Change in Explicit Bias Scores From Baseline to 6 Months
timeFrame: Baseline and 6 months
Other outcomes:
Locations:
city: Migori
country: Kenya
facility: Migori County hospital and sub-county hospitals
Study officials:
affiliation: University of California, San Francisco
name: Patience Afulani, PhD, MD, MPH
role: PRINCIPAL_INVESTIGATOR
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