629 - Family and Provider Perceptions of Health Disparities in the NICU: A Qualitative Study

Poster Number: 629
Publication Number: 629.141

Yasmeen A. Midgette, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Elizabeth E. Halvorson, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Yorjannys Gomez, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, High Point, NC, United States; Rebekah Lassiter, Wake Forest University, Winston-Salem, NC, United States; Allison Chandler, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Modupeola Akinola, Wake Forest University School of Medicine, Winston Salem, NC, United States; Shannon Hanson, Wake Forest University School of Medicine, Winston Salem, NC, United States; Kimberly Montez, Wake Forest University School of Medicine, Winston-Salem, NC, United States

Background: Addressing infant health disparities based on race, ethnicity, and socioeconomic status has been a longtime priority; however, morbidity and mortality in the neonatal intensive care unit (NICU) remain higher in some populations than others. Caregiver and provider perceptions of health disparities in NICU outcomes have not been thoroughly explored.

Objective: The aim was to explore caregiver and provider perceptions of differences in care provided to racial and ethnic minority patients in the NICU that may contribute to disparities.

Design/Methods: This qualitative study was conducted at a level IV NICU. Semi-structured interviews assessed NICU provider perspectives and caregiver experiences after recent NICU discharge. Caregivers of NICU infants hospitalized for ≥7 days whose primary language was English or Spanish were eligible; caregivers of infants not discharged in family members’ custody were excluded. Eligible providers included neonatologists, pediatric trainees, nurse practitioners, and bedside nurses. Purposive sampling ensured ≥50% of caregivers self-reported as racial or ethnic minorities. Interviews were recorded, transcribed, and de-identified. Raw narrative data were systematically analyzed by at least two investigators using a codebook that was iteratively modified. Thematic analysis methods were used to identify emerging themes. Differences were resolved through consensus.

Results: 23 caregivers and 14 providers were interviewed. Caregivers predominantly spoke English (85%); 96% were mothers with a mean age of 32 years. The neonates were predominantly racial and ethnic minorities (62%) and female/male ratio was 1:1. Of providers, 5 were neonatologists/fellows, 6 NNPs/RNs, and 3 residents. Providers predominantly self-identified as White (71%) and female (71%) (tables 1-3). We identified five main themes: bidirectional communication is crucial between providers and families and within the care team; lack of family involvement or role in decision-making may influence NICU outcomes; multiple biases may affect disparities; language barriers and interpreter access play a significant role in providing effective care; and providers and caregivers proposed solutions to improve NICU care (table 4).

Conclusion(s): Our study highlights the importance of considering the experiences of racial and ethnic minority caregivers and adds to the literature as one of the few qualitative studies comparing perceptions of care between providers and caregivers in the NICU setting. Future studies testing interventions to improve disparate outcomes should include input from historically marginalized caregivers.