Improving Provider Comfort in Discussing Race-Based Health Disparities in Pregnant and Birthing People

Background: Race-based health disparities continue in the United States despite directed and significant efforts. Regardless of age, income status, education level, or gender identity, people of color continue to fall victim to higher morbidity and mortality rates compared to White individuals. Considering race and ethnicity are entirely socially constructed, it is plausible that dismantling social perceptions by encouraging providers' to be more vigilant through increased training could be an effective way to correct this injustice. Focusing on racial bias and clinical empathy in maternal health care is critical given ongoing and significant racial-ethnic health disparities among Black, Alaska Native, and Native American pregnant and birthing people. Their risk for maternal mortality is 2.5 times higher than White women. One pervasive problem is the lack of skill-based training for providers on (a) how to recognize moments when issues of race and/or racism may be influencing patient-provider interactions (e.g., race-based neglect, microaggressions, racial insults), (b) how to appropriately ask their patients to disclose moments when they may have experienced racial injustice within healthcare settings, and (c) how to empathically discuss negative race-related incidents with their patients during a clinical visit. A new model of provider skill-based training to address racial disparities in healthcare is needed. Uncovering recurrent insults in the clinical setting can help providers better notice bias and thus begin the journey towards behavioral change. Methods: A DNP midwifery student conducted a quality improvement project to help providers become aware of their own racial implicit biases and address patients' experiences of racism. An education-based toolkit was developed to address this problem. Providers in a university-based midwifery practice received training on the toolkit, which addresses how to discuss patients' current/previous experiences of racism during a clinical visit. Providers received Electronic Medical Record (EMR) templated conversations and reminders to help facilitate dialogue. To assess project effectiveness, participants completed pre-and post-training self-assessment anonymous surveys. Results: A total of 15 providers participated in the training, and 18 providers used the EMR racial- dialogue template in new patient encounters for 6-weeks. Post-intervention results indicated most providers increased comfort in addressing racial disparities, felt more prepared to address racial disparities with patients, and believed this was an important issue to include during patient visits. Finally, most participants indicated they intend to continue asking the question, "Do you feel like your race, ethnicity, or the color of your skin has affected the healthcare you have received either today or in the past?" Conclusions: Training specifically designed to increase provider clinical empathy and racial bias reduction skills appears to be a valuable resource. Based on our findings, providers developed skills and increased comfort in addressing racism directly with their patients. We learned that effective and feasible intervention requires skills-based training and systems processes (i.e., EMR templates). Additionally, we learned that it is feasible to address the issue of racism in healthcare with patients during a clinical visit. Replication of this quality improvement project is needed to determine if similar improvements would be made among different healthcare providers and whether this type of intervention changes patient experiences or outcomes.