Being Known: A Grounded Theory Study of the Meaning of Quality Maternity Care to People of Color in Boston

Abstract

Introduction Experiences of people of color with maternity care are understudied but understanding them is important to improving quality and reducing racial disparities in birth outcomes in the United States. This qualitative study explored experiences with maternity care among people of color to describe the meaning of quality maternity care to the cohort and, ultimately, to inform the design of a freestanding birth center in Boston. Methods Using a grounded theory design and elements of community‐based participatory research, community activists developing Boston's first freestanding birth center and academics collaborated on this study. Semistructured interviews and focus groups with purposefully sampled people of color were conducted and analyzed using a constant comparative method. Interviewees described their maternity care experiences, ideas about perfect maternity care, and how a freestanding birth center might meet their needs. Open coding, axial coding, and selective coding were used to develop a local theory of what quality care means. Results A total of 23 people of color participated in semistructured interviews and focus groups. A core phenomenon arose from the narratives: being known (ie, being seen or heard, or being treated as individuals) during maternity care was an important element of quality care. Contextual factors, including interpersonal and structural racism, power differentials between perinatal care providers and patients, and the bureaucratic nature of hospital‐based maternity care, facilitated negative experiences. People of color did extra work to prevent and mitigate negative experiences, which left them feeling traumatized, regretful, or sad about maternity care. This extra work came in many forms, including cognitive work such as worrying about racism and behavioral changes such as dressing differently to get health care needs met. Discussion Being known characterizes quality maternity care among people of color in our sample. Maternity care settings can provide personalized care that helps clients feel known without requiring them to do extra work to achieve this experience.

Assessing Perception of Prenatal Care Quality Among Black Women in the United States

“…4,10,11 Racial and cultural differences with regard to values, attitudes, preferences, and experiences may affect care that is accepted or received. 12 Underuse of prenatal care among Black women has been associated with health care mistrust and beliefs, 13 perceived discrimination, [14][15][16][17] and unsatisfactory clinical experiences. 13,15,17 This article presents the results of a psychometric evaluation of the Quality of Prenatal Care Questionnaire (QPCQ) to determine validity and reliability for use by Black women.…”

“…29 Final question items of the instrument specifically include questions that address provider-patient communication, patient autonomy and respect, and information sharing: factors that all women, including Black women, consider important during the patient encounter. 15 The QPCQ was developed, tested, and validated in a sample of 80 health care providers, 80 pregnant women, and 844 postpartum women from Canada, 28 and was later validated with 299 postpartum women from Australia. 30 Recently, it was used to assess pregnant and postpartum women's perceptions of access and quality of prenatal care in the United Kingdom.…”

“…The QPCQ is based on Donabedian's model of quality care, which considers the influence of the health care system structure and the prenatal care provider's technical and interpersonal performances as indicators of quality on pregnancy outcomes 29 . Final question items of the instrument specifically include questions that address provider–patient communication, patient autonomy and respect, and information sharing: factors that all women, including Black women, consider important during the patient encounter 15 . The QPCQ was developed, tested, and validated in a sample of 80 health care providers, 80 pregnant women, and 844 postpartum women from Canada, 28 and was later validated with 299 postpartum women from Australia 30 .…”

Adequate Prenatal Care: An Integrative Review

“…The final sample consisted of 13 articles: one psychometric evaluation of a PNC quality assessment tool, 30 a secondary quantitative data analysis, 31 2 approaches to redesigning PNC, 32,33 one single‐site randomized controlled trial, 34 one observational cross‐sectional survey, 35 and 7 qualitative studies 36–42 . Each article was evaluated systematically, examining the focus, stated methods, sample description, and main findings (Table 1).…”

“…Across all reports, study participants equated quality PNC with being patient‐centered and meeting their unique pregnancy needs and concerns. Participants wanted to be treated with respect, 36–39,41,44 obtain access and referrals to resources and support services, 36–41 and receive appropriate education 36,39–42 . Many voiced wanting a relationship with their care team, 37–40 choice 36,39,42 and control, 37,40,42 and access to health insurance and appointments in a timely fashion 36–38,41 .…”