Background: Doulas are trained professionals who provide educational, physical, and spiritual support before, during, and after childbirth. Doula support is associated with improved maternal and infant outcomes. Although limited, research on the benefits of doula care has led to identification of doula care as a strategy to reduce racial/ethnic disparities in maternal and infant health outcomes. Specifically, research on the impact of community doulas is limited; community doulas provide comprehensive services at low or no cost to underserved communities, are often members of the communities they serve, and share cultures and languages with their clients. Stakeholder engagement, particularly from women of color and community doulas whose voices have largely been absent from research and policy conversations, is vital for future PCOR on the impact of community doula care.

Proposed Solution to the Problem: The project team will create a collaborative of stakeholders in California that will facilitate equitable, ethical, and patient-centered outcomes research (PCOR) on community doula care. This approach will be successful because it creates the infrastructure for the development of a shared research agenda that centers women of color and community doulas. California is ideal for this work, given ongoing pilots evaluating the impact of community doula care in San Francisco and Los Angeles, and interest from policy makers to advance Medicaid coverage for doula care.

Objectives: The project’s objective is to establish a collaborative of California stakeholders to develop a research agenda for community doula care as an intervention to advance maternal and infant health equity. The long-term objective is to inform patient-centered, equity-focused, community-informed research on the impact of community doula care.

Activities:

• Create a steering committee with representatives from seven stakeholder groups.
• Conduct a needs assessment to understand stakeholders’ needs and values around research on community doula care.
• Engage stakeholders in a research prioritization process to identify priority unanswered questions and ethical approaches for future PCOR.
• Provide training to collaborative members to increase their capacity to engage in PCOR research.

Outcomes and Outputs (projected): The project will establish the steering committee and collaborative, an engaged and motivated group of stakeholders across California that will have a shared research vision and increased capacity for partnered research. The project team also will publish a report detailing a shared research agenda and strategic direction for patient-centered research on community doula care. Finally, the team will develop an online PCOR training that will be relevant and tailored to stakeholders of community doula care.

Patient and Stakeholder Engagement Plan: Patients include currently/previously pregnant people, including those who worked with a community doula. Other stakeholders are community doulas, clinicians, payers, researchers, public health officials, and policy experts. All stakeholders will be engaged in the steering committee, collaborative, and the needs assessment. Steering committee members, including patients, will participate in monthly videoconference meetings and annual in-person meetings.

Project Collaborators: Collaborators include the University of California, San Francisco; SisterWeb; Diversity Uplifts, Inc.; and Roots of Labor Birth Collective.