Broadening Application of the "Inspiring Change Manual": Training Stakeholders and Doulas

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Background: A considerable racial disparity exists among maternal deaths in the United States. In Texas between 2012-2015, the maternal mortality rate for white women was 27.6 deaths per 100,000 births compared to 42.6 deaths per 100,000 births for black women. Black women are disproportionately impacted by chronic disease and obesity, and therefore, are at a higher risk for peripartum complications than women of other races and ethnicities. Black women have reported receiving substandard care and poor communication with healthcare providers during pregnancy, birth, and postpartum.

Proposed Solution: One intervention that could reduce maternal mortality and morbidity is the use of doulas who provide physical and psychosocial peripartum support to black mothers and can facilitate communication between mothers and healthcare providers.

Objectives: Objectives of this project include adopting and adapting the PCORI-funded tool, Inspiring Change Manual, to train patient and community stakeholders in community-based participatory research (CBPR) methods and strengthening and expanding current stakeholder engagement in the North Texas geographic area regarding reducing maternal mortality for black women. Long-term objectives include conducting patient-centered outcomes research using CBPR methodology regarding the experiences of black mothers who have and have not received doula care, and actively seeking out stakeholders from other regions of Texas who are also engaged in work to reduce maternal mortality for further collaboration.

Activities: Activities of the project include the formation of an advisory board that will plan, recruit participants for, implement, and evaluate CBPR training. Community stakeholders who participate in the CBPR training will collaborate to develop a roadmap for a CBPR agenda.

Outcomes/Outputs: Outcomes of the project include an adapted version of the Inspiring Change Manual for a new patient population, black mothers, in a new geographical area, North Texas, and a roadmap for a CBPR agenda.

Engagement Plan: The patient population for this study is black mothers who have and have not received doula care for a birth within the last three years. Community stakeholders include The Afiya Center (TAC), doulas, an academic researcher, the PCORI-funded developer of the Inspiring Change Manual, doula trainers, clinicians, and Texas health policy makers. The advisory board, consisting of the project leader representing TAC, the project manager who is a doula, the patient coordinator lead, who is a black mother, and the research expert, who is an academic researcher, will meet weekly for three months to plan the CBPR training and recruit black mothers and community stakeholders. The training phase will consist of six monthly sessions where the advisory board and all stakeholders give and receive training and develop the roadmap for the CBPR agenda. The evaluation and dissemination phase will consist of weekly advisory board meetings over two months to analyze project evaluations and plan for dissemination of project outcomes to clinicians and Texas health policy makers. Monthly newsletters will be sent to patient and community stakeholders to communicate next steps with the CBPR agenda.

Collaborators: Collaborating agencies include The Afiya Center, Texas Woman’s University, Illinois Institute for Technology, and Southern Roots Doula Collaborative.