Projects

Active Projects

Past Projects

 

Caring for Providers to Improve Patient Experience (CPIPE) Trial

We were recently awarded a five-year NIH-grant test the effectiveness of the CPIPE intervention, developed during the pilot and recently completed stage. he CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor person-centered maternity care and centers the unique needs of vulnerable women as well as those of providers. CPIPE has 5 components: provider training, peer support, mentorship, embedded champions and leadership engagement. The training includes didactic and interactive content on person-centered maternity care, stress, burnout, bias and handling difficult situations, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The aims of the CPIPE trial are to: Aim 1: to assess the effectiveness of the CPIPE intervention on PCMC in Kenya and Ghana. The investigators hypothesize that CPIPE will improve PCMC for all women, and especially for low SES women. The primary outcome is PCMC measured with the PCMC scale through multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to intervention), midline (6 months post-baseline), and endline (12 months post-baseline) (N=2000 at each time point). A sub-aim 1 will assess the cost-effectiveness of CPIPE. Aim 2: to examine the mechanisms of impact of CPIPE on PCMC. The investigators will assess the effect of CPIPE on intermediate outcomes such as provider knowledge, self-efficacy, stress, burnout, and bias levels; and conduct mediation analysis to assess if changes in these outcomes account for the effect of CPIPE on PCMC. Aim 3: to assess impact of the CPIPE intervention on distal outcomes including maternal health seeking behavior and maternal and neonatal health; and examine if changes in PCMC account for these effects.

 

Evaluation of the Pregnancy Pop-Up Village

Pregnancy care in the U.S., including San Francisco, is characterized by stark inequities in access, patient experience and outcomes. In collaboration with community members, the Pregnancy Pop-Up Village model was developed with the aim of reducing these disparities. The Pop-Up Village is a community-health system-city partnership, delivering co-located clinical care, government/public health entitlements and wraparound services in high-need neighborhoods, as a “one-stop-shop,” on a recurring basis. The current phase focusses on examining the feasibility, community acceptability, sustainability and the preliminary impact. By evaluating experiences and impact for Pregnancy Pop-Up Village beneficiaries (pregnant community members) and providers (those delivering services under this model), we will better understand if this model holds potential as a sustainable and effective mechanism to reduce perinatal care inequities locally and nationally. Learn more on the project's website.

Evaluation of EMBRACE: Perinatal Care for Black Families

Perinatal Care for Black Families is a clinical program developed to give Black mothers and Black pregnant people an opportunity to receive prenatal care from an intentional angle of racial consciousness. Founded by three Black Women, EMBRACE was launched in 2018 to demonstrate that racially concordant and racially responsive prenatal care can lead to better health and mental health outcomes for expecting Black families. EMBRACE asserts a deliberate and unapologetic stance around holding Black mothers, Black pregnant people, and their families with a model of care where social and economic factors that affect their health can be identified and addressed. The program seeks to sustain and support the creation of Black lives with transformative and holistic wellness, and to reclaim cultural wisdom and integrate it in modern, systemic health care as an option for birthing Black families. The purpose of our evaluation of EMBRACE is to determine the efficacy and scalability of EMBRACE by testing it at non-academic settings both within and outside the Bay Area, and with intentional study of the effectiveness of race-concordant care and integration of behavioral health services within group perinatal care. This evidence can then be used to support policies and programs those local governments and medical institutions can fund. Learn more on the project's website.

Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Framework and Indicators

The Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Project is led by a Steering Committee coordinated by the Averting Maternal Death and Disability program at Columbia University Mailman School of Public Health, and includes the London School of Hygiene and Tropical Medicine, UNICEF, UNFPA and WHO. A broad group of global stakeholder organizations and individuals form a wider technical working group to provide substantive and strategic input. The substantive work of review and revision is being conducted through four workstreams and a set of country studies. The entire project will be framed and implemented using principles of human-centered design to ensure that the revised EmONC framework meets the needs and real-world conditions at the national and sub-national policy levels and at the frontline health systems in lower- and middle-income countries. UCSF is co-leading the quality of care and experience of care work group which will focus on incorporating meaningful quality-of-care measures into the framework.

Adaptation of the Person-Centered Prenatal Care Scale for Low- and Middle-Income Countries: Validation in Ghana

This project builds on our prior work developing tools to measure person-centered care during pregnancy and childbirth. We have developed a scale to measure person-centered maternity care in low- and middle-income countries (LMICs), which was validated in Kenya and India. This scale has had widescale uptake and is now being validated in several other settings. We have also developed a scale to measure person-centered prenatal care. But this scale has only been validated in the U.S.; there are still no validated scales for measuring person-centered prenatal care in LMICs. This project therefore seeks to adapt the person-centered prenatal care scale to make it relevant to LMICs and to conduct the first validation study in Ghana.

Person-Centered Care across the Life Course: Needs Assessment in Ghana

Despite the benefits of person-centered care, little research exists on it in Ghana and most of sub-Saharan Africa. A few studies on patient experiences and health system responsiveness have highlighted gaps in patient experience and satisfaction and discrimination in health facilities, which leads to the most vulnerable having the poorest experiences. The media in Ghana has also highlighted the state of person-centered care in Ghana, some of which we have witnessed as clinicians. There is however a dearth of systematic research on the extent of person-centered care in Ghana. We seek to bridge this gap by conducting a needs assessment in Ghana. The needs assessment will involve a review of the literature on person-centered care in Ghana and a qualitative study to identify the gaps in providing it within health facilities in Ghana. The goal of the qualitative study will be to identify unpublished person-centered care activities. This work will inform future work on interventions to improve person-centered care in Ghana.

Past projects

Caring for Providers to Improve Patient Experience (CPIPE)

The goal of this project is to develop, pilot, and evaluate an intervention that helps providers deal with stress and unconscious bias in order to improve the quality of maternal health care in Kenya, particularly the person-centered dimensions of care. Everyone has right to dignified and respectful health care. Yet evidence shows that, globally, women are mistreated during childbirth. The research preceding this project contributed to improved measurement of person-centered maternity care and better understanding of the factors that contribute to poor person-centered maternity care. The current project extends this work to develop an intervention that addresses some of the drivers identified in the first phase. We focus on healthcare provider stress and unconscious bias because they are mutually reinforcing drivers of poor-quality care rarely considered in quality improvement projects in sub-Saharan Africa. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor person-centered maternity care and centers the unique needs of vulnerable women as well as those of providers. CPIPE has 5 components: provider training, peer support, mentorship, embedded champions and leadership engagement. The training includes didactic and interactive content on person-centered maternity care, stress, burnout, bias and handling difficult situations, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. This intervention will advance the evidence base for interventions to improve person-centered maternity care and has great potential to improve equity in maternal and neonatal health.

Understanding the Drivers of Poor Person-Centered Maternity Care in Ghana

The objective of this project is to examine the drivers of poor person-centered maternity care in Ghana. In addition to an exploratory approach to examine the drivers more broadly, we focus on understanding the role of three factors—provider stress, implicit bias and difficult situations—that we posit are key drivers of poor person-centered maternity care and contribute to disparities. We focus on these three factors because they have received little attention in the quality-of-care dialogue in sub-Saharan Africa, although literature from high-income settings shows that these factors contribute to poor patient provider interactions and lead to disparities in care.

Experiences of Health Care Workers in Kenya and Ghana during COVID

Many healthcare providers in developing countries, including Ghana, voiced concerns about lack of preparedness at their health facilities in the early phase of the COVID-19 pandemic to handle infections with the new disease. Many also expressed fears of being infected, with effects on stress, burnout, satisfaction and motivation levels. Few studies were documenting and examining these issues in Ghana and Kenya. Because we were already working on provider mental health, we moved to study the effects of COVID as well, as this had implications for person-centered care. We conducted an explanatory sequential mixed-methods study using a cross-sectional online survey followed by in-depth interviews to document these concerns and to examine the associated psychological effects. Learn more by visiting the project website.

Measuring Person Centered Maternity Care for Women of Color in California

Socially driven issues, such as disrespect, abuse and discrimination within the health care system, play a significant role in how women of color experience care during pregnancy, birth, and postpartum. Experience influences access, and access influences outcomes for mother and baby. Women of color have repeatedly described disrespectful care experiences, including loss of autonomy and self-determination. As we move from describing preterm birth disparities to action-based research, we need measurement tools that adequately capture the care experiences of women at most risk for preterm birth. We aimed to 1) use community engaged approaches to adapt a quantitative scale to measure person-centered maternity care for women of color in the United States; and 2) describe the extent to which women in the study population are receiving person-centered maternity care. We used a mixed-methods approach including qualitative interviews for developing and refining items and quantitative data for psychometric analysis.

Perceived Quality of Care during Childbirth (PQCC) Study

Perceived poor quality of care contributes significantly to the lower-than-expected use of maternal health services in sub-Saharan Africa. These perceptions are especially related to women’s experiences during childbirth—the person-centered dimensions of maternity care. There are, however, few quantitative studies on this topic in sub-Saharan Africa due to a lack of validated tools. The goal of this project was to understand community perceptions of quality of care during childbirth, focusing on person-centered maternity care. A key objective was to develop a tool to measure person-centered maternity care in low resource settings. In addition, we collected quantitative and qualitative data to understand the factors contributing to poor person-centered maternity care from the perspective of both recipients and providers of care. We conducted structured interviews with over 1,000 women and nearly 200 of their family members, eight focus group discussions involving 54 women, and in-depth interviews with about 49 providers in Migori County, Kenya.

Addressing Demand and Supply-Side Factors to Improve Maternal and Newborn Health in Northern Ghana

This project brought together a transdisciplinary team of collaborators to address both the demand and supply forces that impact use of maternal and newborn services to improve maternal and neonatal outcomes in East Mamprusi district in Northern Ghana. We aimed to (1) use women’s groups and community volunteers to provide outreach to pregnant and newly delivered women in East Mamprusi district to increase timely antenatal attendance, facility-based delivery, and prompt post-natal care; (2) implement a simulation training for providers at four health centers and one referral hospital that were jointly responsible for the majority of facility-based maternal and newborn care in the district, in order to ensure that women arriving for maternal and neonatal care obtain high quality, respectful care; and (3) use implementation science methodology to identify and document challenges, successes and solutions in implementation to prepare for broader scale-up beyond East Mamprusi.