Using human centered design to identify opportunities for reducing inequities in perinatal care

Autor: Lara Chehab, Devika Patel, Courtney R. Lyles, Amanda Sammann, Malini A. Nijagal, Jennifer Liao, Schyneida Williams
Rok vydání: 2021
Předmět:
Perinatal care
8.1 Organisation and delivery of services
Nursing
Peer support
Basic Behavioral and Social Science
Health administration
Human-centered design
03 medical and health sciences
0302 clinical medicine
Library and Information Studies
Pregnancy
Clinical Research
Brainstorming
Behavioral and Social Science
Health care
Humans
Medicine
030212 general & internal medicine
Child
User-centered design
Medical education
030505 public health
Medicaid
business.industry
Research
Prevention
Health Policy
Nursing research
Infant
Newborn
Infant
Prenatal Care
Focus Groups
Universal Design
Health Services
Newborn
Focus group
United States
Good Health and Well Being
Public Health and Health Services
Health Policy & Services
Female
Public aspects of medicine
RA1-1270
Thematic analysis
0305 other medical science
business
Health and social care services research
Zdroj: BMC health services research, vol 21, iss 1
BMC Health Services Research, Vol 21, Iss 1, Pp 1-15 (2021)
BMC Health Services Research
ISSN: 1472-6963
DOI: 10.1186/s12913-021-06609-8
Popis: Background Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. Methods We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community, with a specific emphasis on representation from marginalized communities. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events and engagement with a diverse community advisory group. Results We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop. Conclusions Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities, and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding and centering the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions.
Databáze: OpenAIRE
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