Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study

Area of Science:

• Public Health
• Sociology
• Maternal Health

Background:

• Maternal mortality in the U.S. disproportionately affects women based on race and socioeconomic status (SES).
• Societal discrimination and patient-provider relationship quality are linked to adverse maternal outcomes.
• The interplay between societal discrimination and patient-provider relationships in maternal health remains under-explored.

Purpose of the Study:

• To investigate the association between societal discrimination and patient-provider relationship quality among perinatal women.
• To explore how experiences of discrimination manifest within patient-provider dynamics.
• To understand the role of race and SES in these associations.

Main Methods:

• Mixed methods design utilizing a sequential explanatory approach.
• Quantitative phase: Path analysis via structural equation modeling of a representative survey (n=244).
• Qualitative phase: Thematic analysis of focus groups (n=34) with survey participants.

Main Results:

• Race and SES significantly predicted experiences of societal discrimination.
• Societal discrimination positively correlated with vigilant behaviors during healthcare interactions.
• Increased vigilant behaviors were associated with poorer patient-provider relationship quality.
• Qualitative data revealed specific pathways linking provider discrimination, vigilance, and relationship quality, especially among women of color.

Conclusions:

• Quantitative findings support a model where race and SES influence societal discrimination, which affects vigilant behaviors and patient-provider relationship quality.
• Qualitative data offer insights into how these mechanisms operate in clinical settings.
• Establishing trust is crucial for patient-provider relationships, particularly for women of color, to mitigate negative impacts of discrimination.