RESUMEN
The Centering Equality, Race, and Cultural Literacy in Family Planning (CERCL-FP) program aims to break racial silence and dismantle structural racism in the field of family planning, by providing racial equity workshops and trainings. OBJECTIVE: The objective of this study was to begin a multi-phased, rigorous evaluation to determine the impact and outcomes of the work of CERCL-FP. STUDY DESIGN: A needs assessment with former graduates and current directors of fellowships in family planning was conducted using qualitative interviews. The focus of these interviews was to determine the ability, readiness, and willingness of the field of family planning to retrofit new curricula grounded in equity, race, and cultural literacy. RESULTS: Nine (N = 9) interviews were completed with seven board certified obstetrician-gynecologists and two board certified family medicine physicians. Three themes were identified: (1) Establishing the Distribution of Work; (2) The Push/Pull of Change from Inside and Outside: Curricula and Faculty Responsibilities; and (3) Reproductive Justice and Fellowships in Family Planning. Despite acknowledging the need to retrofit the field of family planning with content grounded in equity, race, and cultural literacy, there are structural, institutional, and individual level barriers that have limited the adoption of CERCL-FP curricula within family planning curriculum nationwide. CONCLUSION: Findings from this study illuminate multiple barriers that should be considered when expanding foundational knowledge of clinicians and researchers. IMPLICATIONS: Similar to the slow integration of research findings into clinical practice, this study shows that integration of social science and new curricula within the field of family planning faces significant barriers. Strategies to address these barriers are crucial to ensuring successful integration of equity, race, and cultural literacy within family planning.
RESUMEN
BACKGROUND: Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS: PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS: Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS: The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.