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Implicit racial bias in prenatal visit patient-clinician communication, prenatal screening, and interventions

Olaniyan, Abisola (2021) Implicit racial bias in prenatal visit patient-clinician communication, prenatal screening, and interventions. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Racial/ethnic disparity in maternal health outcomes persists in the United States. The Institute of Medicine's report suggests that the racial and ethnic differences in the quality of care and existing healthcare disparities are likely related to healthcare clinicians' prejudices and biases, which could affect patient-clinician interactions, screening, diagnosis, and treatment. This unequal treatment may also play a role in the racial inequities in maternal healthcare quality and maternal morbidity and mortality rate.
This paper explores racial differences in patient-clinician communication and obstetrical care practices such as illicit drug testing and involvement of child protective services. We hypothesized that racial differences and biases exist in obstetric clinicians' care. Additionally, we explored study participants' perceptions of clinicians' communication behaviors during their initial prenatal visit and examined for racial differences in patients' reflections.
We utilized data from an NIH-funded study (Talking to Pregnant Patients), an observational study of patient-clinician communication regarding substance use in first prenatal visits. Some clinician participants consulted with more than one patient participant; therefore, we utilized generalized estimated equation for correlated data in all regression analyses to account for nonindependence across observations. Additionally, we performed a mixed-method analysis of the semi-structured patient interviews to elucidate patients’ perceptions of clinicians' communication behaviors and explore racial differences in these reports.
Our study found significant racial differences in clinician communication patterns and illicit drug use testing for patients who disclosed illicit drug use to their clinician during the initial prenatal visit. Black patients were more likely to receive stereotypical and inappropriate comments from their clinicians when compared to White patients. Additionally, Black patients who disclosed illicit drug use to their clinicians had higher odds of clinicians conducting urine toxicology testing than their White counterparts. Furthermore, during the semi-structured interviews, Black patients were more likely to discuss clinicians' negative communication behaviors than White patients.
Our study shows racial differences in the quality of prenatal care received by pregnant people, which could be due to clinicians' personally mediated racist practices. Addressing these contributing factors to racial inequities in maternal healthcare would be invaluable in reducing the racial gaps in maternal and child health outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Olaniyan, Abisolaabo12@pitt.eduABO12
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHawk, Mary E.mary.hawk@pitt.edumary.hawk
Committee MemberChang, Judychanjc@upmc.educhanjc
Committee MemberMendez, Dara D.ddm11@pitt.eduddm11
Committee MemberAlbert, Steven M.smalbert@pitt.edusmalbert
Date: 12 May 2021
Date Type: Publication
Defense Date: 22 April 2021
Approval Date: 12 May 2021
Submission Date: 29 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 192
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: maternal health, prenatal care, racial disparity, racial inequity, racism, personally mediated racism, racial bias
Date Deposited: 12 May 2021 19:46
Last Modified: 12 May 2023 05:15


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