Designing prenatal care for low-income, black patients in urban settings using human centered design

Objective: Black and low-income pregnant patients face significant inequities in health care access and outcomes in the United States. Yet, these patients’ voices have been largely absent from designing improved prenatal care models. Our objective was to use Human Centered Design to examine patients’ and health care workers’ experiences with prenatal care delivery in a largely low-income, Black population, to inform future care innovations to improve access, quality, and outcomes. Study Design: Using snowball sampling, we conducted Human Centered Design-informed interviews with low-income, Black patients and health care workers in a large, urban setting. Interview questions addressed the first two Human Centered Design phases: 1) observation: understanding the problem from the end-user’s perspective, and 2) ideation: generating novel potential solutions. We assessed these questions for the three key components of prenatal care: medical care, anticipatory guidance, and psychosocial support. Results: Nineteen patients and 19 health care workers were interviewed. All patients were Black, and the majority had public insurance (17/19, 89.5%). Health care workers included doctors, midwives, breastfeeding counselors, doulas, and social workers. Participants affirmed the three goals of prenatal care. Participants reported failures of current prenatal care delivery and potential solutions for each of the three goals (medical care, anticipatory guidance, and psychosocial support) and two overarching categories: maternity care professionals and care structure. Participants reported in an ideal model, patients would have strong relationships with their maternity care professional who would be at the center of all prenatal care services. Additionally, care would be tailored to individual patients and use care navigators, flexible models, and colocation of services, to reduce barriers. Conclusion: Current prenatal care delivery fails to meet low-income, Black patients’ needs. Ideal prenatal care delivery includes more comprehensive, integrated services tailored to patients’ medical needs and preferences

Extending Sustainable Irrigation Opportunities to Socially and Historically Disadvantaged Farmers in the Alabama Black Belt to Support Commercial-Level Production

This paper focuses on providing sustainable irrigation opportunities to socially and historically disadvantaged farmers (SHDFs). The ability to provide steady production capacity through the use of renewable energy sources and microirrigation is innovative, in that it demonstrated how to develop and utilize a sustainable irrigation system in both energy and water conservation. This venture is also innovative in that it sought to provide SHDFs with irrigation in a state in which irrigation in agriculture is minimal, while at the same time, offsetting the energy costs that normally accompany irrigation. Several farmers are profiled in their participation in the irrigation program. The lessons learned will provide a starting point for a more permanent research, educational, and outreach partnership between the United States Department of Agriculture (USDA) and SHDF clientele. This relationship will lead to further strengthening the relationships between Tuskegee University and both participating farmers and USDA agencies. Key Words: Irrigation, Small Farmers, Agricultural Sustainability, Solar Energy, Black Bel

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US: A Qualitative Study

IMPORTANCE: Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. OBJECTIVE: To examine patients\u27 and health care workers\u27 experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. DESIGN, SETTING, AND PARTICIPANTS: For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user\u27s perspective) and ideation (generating novel potential solutions). Questions targeted participants\u27 experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. MAIN OUTCOMES AND MEASURES: Preferences for prenatal care redesign. RESULTS: Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. CONCLUSIONS AND RELEVANCE: In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients\u27 needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients\u27 social needs and preferences

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

EXTENDING SUSTAINABLE IRRIGATION OPPORTUNITIES TO SOCIALLY AND HISTORICALLY DISADVANTAGED FARMERS IN THE ALABAMA BLACK BELT TO SUPPORT COMMERCIAL-LEVEL PRODUCTION

This paper focuses on providing sustainable irrigation opportunities to socially and historically disadvantaged farmers (SHDFs). The ability to provide steady production capacity through the use of renewable energy sources and microirrigation is innovative, in that it demonstrated how to develop and utilize a sustainable irrigation system in both energy and water conservation. This venture is also innovative in that it sought to provide SHDFs with irrigation in a state in which irrigation in agriculture is minimal, while at the same time, offsetting the energy costs that normally accompany irrigation. Several farmers are profiled in their participation in the irrigation program. The lessons learned will provide a starting point for a more permanent research, educational, and outreach partnership between the United States Department of Agriculture (USDA) and SHDF clientele. This relationship will lead to further strengthening the relationships between Tuskegee University and both participating farmers and USDA agencies

They\u27re Doing Their Job : Women\u27s Acceptance of Emergency Department Contraception Counseling.

STUDY OBJECTIVE: We explore reproductive-aged women\u27s acceptance of contraception counseling in the emergency department (ED). METHODS: This study is phase 1 of an exploratory sequential mixed methods study. We purposively interviewed 31 participants with the following criteria: black, white, or Latina race/ethnicity; nonpregnant; aged 15 to 44 years; receiving nonemergency care; not using highly effective contraception; and did not intend to become pregnant. We conducted semistructured interviews with a piloted interview guide until reaching thematic saturation. We coded transcripts with an iteratively developed codebook, maintaining intercoder agreement greater than 80%. Qualitative acceptance of ED contraception counseling was grouped into 3 categories: acceptable, unacceptable, and equivocal. We conducted a thematic text analysis to assess themes expressing support and concern for ED contraception counseling. Qualitative findings were stratified by age, race, and frequency of ED use. Using components of grounded theory, we developed a conceptual model. RESULTS: Most participants (81%) accepted ED contraception counseling. Themes expressing support and concern for ED contraception counseling included opportunity to address women\u27s unmet contraception needs, contraception is within the scope of ED practice, the ED is a convenient setting with competent providers, contraception is a sensitive topic, and the ED may be an inappropriate setting for some women. Latina participants had lower acceptance of ED contraception counseling. Dominant subthemes varied slightly by race, age, and frequency of ED use. CONCLUSION: Diverse women had high acceptance of contraception counseling in the ED. Perspectives expressing both support and concern in regard to ED contraception counseling were explored in detail