7 - Experiences within a perinatal medical home model: A qualitative study.

Poster Number: 7
Publication Number: 7.414

Kasee L. Houston, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Helia Imany-Shakibai, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Flor Arellano, UCLA Mattel Childrens Hospital, Pacoima, CA, United States; Erin Saleeby, Harbor UCLA Medical Center, Los Angeles, CA, United States; Rebecca Dudovitz, University of California Los Angeles, Los Angeles, CA, United States; Adam Schickedanz, UCLA, Los Angeles, CA, United States

Background: Racial inequities in preterm birth - linked to chronic stress from racism, have been well described. The Los Angeles County Maternity Assessment Management Access and Service Synergy throughout the Neighborhood program (MAMAs) is a comprehensive perinatal medical home program, designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates by 79% in Black participants after program implementation from 2015 to 2017. Yet, the mechanism of this reduction is unknown.

Objective: To understand the experiences of staff and clients within the MAMAs program in order to identify what factors enable successful reduction of preterm birth, the challenges and opportunities of optimizing health during the COVID-19 pandemic, and how the program addresses racism.

Design/Methods: We conducted English and Spanish one-hour semi-structured interviews via phone or video conferencing from November 2020-December 2021 interviewing 21 MAMAs staff and 24 perinatal clients. Separate interview guides for staff and clients were used and explored experiences within the MAMAs program, experiences during the COVID-19 pandemic, and how racism affects MAMAs clients. Interviews were recorded and transcribed. Analysis was conducted using a phenomenologic framework. Coding was performed using grounded theory analysis with the goal of identifying themes from staff and patients separately, as well as cross-cutting themes from both groups of participants.

Results: Preliminary analysis revealed 6 key themes from the staff interviews: above and beyond care, connection during COVID-19, emotional support, stressors patients face, staff fulfillment, and naming racism (Table 1). Preliminary client interview analysis found 5 key themes: Praise of MAMAs, mental health, adaptation to COVID-19, praise of MAMAs program, barriers to care, and racism (Table 2). Overall, staff and clients express appreciating the MAMAs program’s ability to build trusting relationships, clients underscored feeling that they received continuous emotional support and empowerment, especially during the challenges from COVID-19 pandemic. Clients and staff noted job and housing loss, food insecurity, intimate partner violence, depression, and anxiety due to the pandemic. The staff and clients work closely together to address social needs in order to directly address chronic stress and indirectly address racism in their daily lives.Conclusion(s): Relationship building is a cornerstone of the program’s success and plays a significant role in alleviating chronic stress in this population.
Kasee Houston, MD/MPP CVCV Kasee Houston PAS.pdf
Table 2Client Interview Key Themes