517 - Qualitative Insights on Improving Quality of Care for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Mothers and Infants

Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) are the fastest growing racial/ethnic group in the United States. In California, 16% of births are among AANHPI families. Data aggregation obscures meaningful differences between these diverse populations. To understand how multilevel factors influence poor quality of care, we convened an AANHPI Birth Equity Conference with community leaders, caregivers, and researchers across California.

Objective:

Our objective was to analyze responses to pre-conference survey questions on key drivers and examples of inequitable care of AANHPI mothers and infants.

Design/Methods:

In this qualitative study, we analyzed conference registrants’ responses to two open-ended questions: “What are the two most important quality of care issues facing AANHPI mothers and/or babies?” and “Have you witnessed disparate care impacting AANHPI mothers and babies? If yes, briefly describe the disparate care and its impact.” We collected patient race/ethnicity to facilitate disaggregation. Data analysis was conducted using Dedoose, an online mixed methods analytic tool (Version 9.0. 17). Two researchers coded the responses, and differences in coding were adjudicated by group consensus.

Results:

From 454 registrants, we collected 278 responses on AANHPI quality of care issues. Key issues identified included Access to Culturally Appropriate Quality Care and Resources, Healthcare Provider Education, Language, Bias/Discrimination in Healthcare, and Data Quality. Overall analysis of the 118 disparity stories yielded key themes of Communication, Dismissive Treatment, and Cultural Factors (Table 1). Other themes identified included Unequal Treatment and Disrespectful Care. Disaggregating patient experience in disparity stories demonstrated differences by population, with Language Concordance most salient for Chinese and Asian-multiple groups (Table 2).  Cultural Factors as a theme predominated in all populations, highlighting tensions between western medicine and culturally specific practices and beliefs.

Conclusion(s):

Survey respondents identified many instances of biased care directed at AAHNPI families. Additional research, including interviews of AANHPI families and their healthcare providers, is needed to improve quality of care and cross-cultural communication in maternal and neonatal care.