583 - Experiences of Latina clients within a comprehensive perinatal medical home addressing social determinants of health: A secondary qualitative analysis.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 583
Publication Number: 583.413

Kasee 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; Ashaki M. Jackson, Los Angeles County Department of Health Services, Alhambra, CA, United States; Erin Saleeby, UCLA, Los Angeles, CA, United States; Flor Arellano, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Rebecca Dudovitz, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Adam Schickedanz, UCLA, Los Angeles, CA, United States

Presenting Author(s)

Kasee Houston, MD/MPP (she/her/hers)

Fellow Physician
UCLA Mattel Children's Hospital
Los Angeles, California, United States

Background:

The Los Angeles County Maternity Assessment and Management Access Service Synergy (MAMA’s) Neighborhood program is a comprehensive perinatal medical home program which aims to reduce racial inequities in preterm birth by alleviating the impacts of chronic stress and addressing social determinants of health. The program’s participants are ~3/4 Latina. In a previous analysis, the program reduced odds of preterm birth rates by 79% in Black participants after program implementation but did not decrease rates among the whole group. The mechanism of this decrease is unknown.

Objective:

To evaluate the experiences of Latina clients in the program and how they differ from Black participants, to better understand program strengths and opportunities for improvement in decreasing preterm birth.

Design/Methods:

We conducted a secondary analysis of qualitative data from 21 MAMA’s staff and 34 perinatal clients who were interviewed in one-hour semi-structured interviews via phone or video conferencing from November 2020-February 2022. 35% of client interviews were conducted in Spanish. Separate interview guides for staff and clients were used to explore experiences within the MAMA’s program, experiences during the COVID-19 pandemic, and how racism and discrimination affects MAMA’s clients. Interviews were recorded, transcribed, and translated to English. 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:

100% of participants were female (Table 1). Regardless of race or ethnicity, clients and staff described relationship building as a cornerstone of the MAMA’s program that plays a significant role in alleviating chronic stress for participants. Secondary analysis results found that clients who identified as Latina, were undocumented, or Spanish Speaking had unique experiences and barriers to care related to 1) limited English proficiency, 2) US citizenship status, and 3) interpersonal stressors, with subthemes including language barriers and prolonged wait times, policy and eligibility threats, and embarrassment and stigma (Table 2).

Conclusion(s):

Clients who identified as Latina, undocumented, or Spanish Speaking faced unique stressors. There is opportunity for further investigation to identify how to address these stressors and potentially decrease preterm birth among this population.