Caring for Providers to Improve Patient Experience Study Phase 2 in Migori County

NCT05019131 | Completed Results

• 2 other identifiers: A135552R00HD093798
• Study Type: interventional
• Target: 83
• Locations: 1 country
• Sites: 1

Brief Summary

The activities described in this proposal are aimed at addressing health care provider stress and unconscious bias to improve quality of maternal health care, particularly related to the person-centered dimensions of care-i.e. care that is respectful and responsive to women's needs, preferences, and values. The investigators focus on health provider stress and unconscious bias because they are key drivers of poor-quality care that are often not addressed in interventions designed to improve quality of maternal health care. The investigators plan to (1) design an intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on: (a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider stress levels.

Conditions

Maternal Health; Mental Health; Healthcare Provider; Adverse Outcomes; Stress; Stress, Psychological; Stress, Emotional; Quality of Care; Burnout; Discrimination, Social

Keywords

providers; mental health; unconscious bias; prejudice; Kenya; stress; burnout; person-centered care; quality of care; discrimination

Outcome Measures

Primary Outcomes (4)

• Change in Perceived Stress Scale (PSS) Score From Baseline to 6 Months

  The Perceived Stress Scale (PSS) score ranges from 0 to 40 with higher scores indicating higher perceived stress.

  Baseline and 6 months

• Change in Shirom-Melamed Burnout Measure (SMBM) Score From Baseline to 6 Months

  The Shirom-Melamed Burnout Measure range from 1 to 7 with higher scores indicating higher burnout

  Baseline and 6 months

• Change in Stress Knowledge and Attitudes Score From Baseline to 6 Months

  The stress knowledge and attitudes score is measured by 14 survey questions with scores ranging from 0 to 14. Higher scores indicate higher knowledge and positive attitudes regarding stress and stress management. We used 13 of the items from the 14-item survey scale. The score range used is 0 to 13- as noted in the limitations section.

  Baseline and 6 months

• Change in Unconscious Bias Knowledge and Attitudes Score From Baseline to 6 Months

  The unconscious bias knowledge and attitudes score is measured by 17 survey questions with scores ranging from 0 to 17. Higher scores indicate higher knowledge and positive attitudes regarding unconscious bias and unconscious bias mitigation

  Baseline and 6 months

Secondary Outcomes (4)

• Change in Hair Cortisol Levels From Baseline to 6 Months

  Baseline and 6 months

• Change in Heart Rate Variability (HRV) Levels From Baseline to 6 Months

  Baseline and 6 months

• Change in Socioeconomic Status-person Centered Maternity Care Implicit Association Test (IAT) Score

  Baseline and 6 months

• Change in Explicit Bias Scores From Baseline to 6 Months

  Baseline and 6 months

Study Arms (2)

Intervention arm

EXPERIMENTAL

1. Training: The investigators will develop a training for providers that addresses the following topics: Stress \& positive coping mechanisms; Unconscious bias awareness and mitigation; Person-centered maternity care; Dealing with difficult situations; and Teamwork and communication; 2. Peer support and mentorship: The investigators will identify what works best for these groups in terms of group composition, size, and how the groups want to interact. 3. Leadership engagement: To ensure leadership buy in, support and sustainability of the intervention, the investigators will engage leadership of the County. 4. Embedded champions: To facilitate ongoing engagement, the investigators will identify local leaders, and invite them to training where they will be taught how to facilitate peer support groups and serve as champions.

Behavioral: Training; Behavioral: Peer support and mentorship; Behavioral: Leadership engagement; Behavioral: Embedded champions

Control arm

NO INTERVENTION

Will not receive any training during the intervention period

Interventions

Training BEHAVIORAL

trainings to reduce conscious bias and stress

Intervention arm

Peer support and mentorship BEHAVIORAL

facilitated peer and mentorship opportunities

Intervention arm

Leadership engagement BEHAVIORAL

Engaged leadership at the county and facility levels

Intervention arm

Embedded champions BEHAVIORAL

Facilitate local champions to promote intervention

Intervention arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Providers working in maternity units of the intervention facilities are all eligible.

You may not qualify if:

• Inability to attend scheduled training.

Sponsors & Collaborators

• University of California, San Francisco: lead
• Kenya Medical Research Institute: collaborator
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

Migori County hospital and sub-county hospitals

Migori, Kenya

Location

Related Publications (84)

• WHO, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2013 [Internet]. WHO. 2014 [cited 2014 Jul 17]. Available from: http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html

  BACKGROUND

• Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009 Aug 11;9:34. doi: 10.1186/1471-2393-9-34.

  PMID: 19671156 BACKGROUND

• Moyer CA, Mustafa A. Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review. Reprod Health. 2013 Aug 20;10:40. doi: 10.1186/1742-4755-10-40.

  PMID: 23962135 BACKGROUND

• Graham WJ, McCaw-Binns A, Munjanja S. Translating coverage gains into health gains for all women and children: the quality care opportunity. PLoS Med. 2013;10(1):e1001368. doi: 10.1371/journal.pmed.1001368. Epub 2013 Jan 15.

  PMID: 23335862 BACKGROUND

• van den Broek NR, Graham WJ. Quality of care for maternal and newborn health: the neglected agenda. BJOG. 2009 Oct;116(Suppl 1):18-21. doi: 10.1111/j.1471-0528.2009.02333.x.

  PMID: 19740165 BACKGROUND

• Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014 Sep 19;11(1):71. doi: 10.1186/1742-4755-11-71.

  PMID: 25238684 BACKGROUND

• Friberg IK, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MO, Bergh AM, Walker N, Weissman E, Chopra M, Black RE; Science in Action: Saving the lives of Africa's Mothers, Newborns, and Children working group; Axelson H, Cohen B, Coovadia H, Diab R, Nkrumah F. Sub-Saharan Africa's mothers, newborns, and children: how many lives could be saved with targeted health interventions? PLoS Med. 2010 Jun 21;7(6):e1000295. doi: 10.1371/journal.pmed.1000295.

  PMID: 20574515 BACKGROUND

• Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comande D, Diaz V, Geller S, Hanson C, Langer A, Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi VN, Robinson N, Skaer M, Souza JP, Vogel JP, Althabe F. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016 Oct 29;388(10056):2176-2192. doi: 10.1016/S0140-6736(16)31472-6. Epub 2016 Sep 16.

  PMID: 27642019 BACKGROUND

• Leavitt M. Medscape's response to the Institute of Medicine Report: Crossing the quality chasm: a new health system for the 21st century. MedGenMed. 2001 Mar 5;3(2):2. No abstract available.

  PMID: 11549951 BACKGROUND

• Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Saraiva Coneglian F, Diniz AL, Tuncalp O, Javadi D, Oladapo OT, Khosla R, Hindin MJ, Gulmezoglu AM. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med. 2015 Jun 30;12(6):e1001847; discussion e1001847. doi: 10.1371/journal.pmed.1001847. eCollection 2015 Jun.

  PMID: 26126110 BACKGROUND

• Abuya T, Warren CE, Miller N, Njuki R, Ndwiga C, Maranga A, Mbehero F, Njeru A, Bellows B. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS One. 2015 Apr 17;10(4):e0123606. doi: 10.1371/journal.pone.0123606. eCollection 2015.

  PMID: 25884566 BACKGROUND

• Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM. 'They treat you like you are not a human being': maltreatment during labour and delivery in rural northern Ghana. Midwifery. 2014 Feb;30(2):262-8. doi: 10.1016/j.midw.2013.05.006. Epub 2013 Jun 19.

  PMID: 23790959 BACKGROUND

• Tuncalp O, Hindin MJ, Adu-Bonsaffoh K, Adanu R. Listening to women's voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana. PLoS One. 2012;7(8):e44536. doi: 10.1371/journal.pone.0044536. Epub 2012 Aug 31.

  PMID: 22952992 BACKGROUND

• Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OM, Feigl AB, Graham WJ, Hatt L, Hodgins S, Matthews Z, McDougall L, Moran AC, Nandakumar AK, Langer A. Quality maternity care for every woman, everywhere: a call to action. Lancet. 2016 Nov 5;388(10057):2307-2320. doi: 10.1016/S0140-6736(16)31333-2. Epub 2016 Sep 16.

  PMID: 27642018 BACKGROUND

• Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016 Jul 18;13(1):79. doi: 10.1186/s12978-016-0187-z.

  PMID: 27424608 BACKGROUND

• Ratcliffe HL, Sando D, Mwanyika-Sando M, Chalamilla G, Langer A, McDonald KP. Applying a participatory approach to the promotion of a culture of respect during childbirth. Reprod Health. 2016 Jul 18;13(1):80. doi: 10.1186/s12978-016-0186-0.

  PMID: 27424514 BACKGROUND

• Filby A, McConville F, Portela A. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective. PLoS One. 2016 May 2;11(5):e0153391. doi: 10.1371/journal.pone.0153391. eCollection 2016.

  PMID: 27135248 BACKGROUND

• UNC Executive Development. The Real Effects of Unconscious Bias in the Workplace [Internet]. 2015 [cited 2016 Oct 26]. Available from: http://execdev.kenan-flagler.unc.edu/blog/the-real-effects-of-unconscious-bias-in-the-workplace-0

  BACKGROUND

• Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad Med. 2012 Jul;87(7):845-52. doi: 10.1097/ACM.0b013e318258338d.

  PMID: 22622217 BACKGROUND

• Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med. 2012 Jul;87(7):853-8. doi: 10.1097/ACM.0b013e3182583536.

  PMID: 22622219 BACKGROUND

• Andersen HM. "Villagers": differential treatment in a Ghanaian hospital. Soc Sci Med. 2004 Nov;59(10):2003-12. doi: 10.1016/j.socscimed.2004.03.005.

  PMID: 15351468 BACKGROUND

• Glanz K, Rimer KB. Theory at a Glance: A Guide for Health Promotion Practice. National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. NIH Pub. No. 97-3896. Washington, DC: NIH. 1997.

  BACKGROUND

• San Francisco Department of Public Health. Trauma Informed Systems Initiative 2014 Year in Review [Internet]. 2015. Available from: http://www.leapsf.org/pdf/Trauma-Informed-Systems-Initative-2014.pdf

  BACKGROUND

• McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988 Winter;15(4):351-77. doi: 10.1177/109019818801500401.

  PMID: 3068205 BACKGROUND

• Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016 Jan 30;387(10017):462-74. doi: 10.1016/S0140-6736(15)00838-7. Epub 2015 Nov 13.

  PMID: 26584737 BACKGROUND

• WHO. PMNCH Fact Sheet: Maternal mortality [Internet]. 2011 [cited 2013 Jul 16]. Available from: http://www.who.int/pmnch/media/press_materials/fs/fs_mdg5_maternalmortality/en/index.html

  BACKGROUND

• WHO. Making pregnancy safer: the critical role of the skilled attendant. Jt Statement WHO ICM FIGO Geneva. 2004;

  BACKGROUND

• Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006 Apr 1;367(9516):1066-1074. doi: 10.1016/S0140-6736(06)68397-9.

  PMID: 16581405 BACKGROUND

• Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. doi: 10.1016/S2214-109X(14)70227-X. Epub 2014 May 5.

  PMID: 25103301 BACKGROUND

• WHO. Global Health Observatory Data Repository, MDG 5: Maternal health: [Internet]. 2013 [cited 2013 Sep 5]. Available from: http://apps.who.int/gho/data/node.main.REPWOMEN39

  BACKGROUND

• March of Dimes, PMNCH, Save the Children. Born Too Soon: The Global Action Report on Preterm Birth. Eds CP Howson, MV Kinney, JE Lawn. World Health Organization, Geneva; 2012.

  BACKGROUND

• Kenya National Bureau of Statistics, Ministry of Health, National AIDS Control Council, Kenya Medical Research Institute, National Council for Population and Development, Nairobi, Kenya, and The DHS Program, ICF International, Rockville, Maryland, USA. The DHS Program - Kenya: DHS, 2014 - Final Report (English) [Internet]. 2015 [cited 2016 Feb 18]. Available from: http://dhsprogram.com/publications/publication-FR308-DHS-Final-Reports.cfm

  BACKGROUND

• Anwar I, Kalim N, Koblinsky M. Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh. J Health Popul Nutr. 2009 Apr;27(2):139-55. doi: 10.3329/jhpn.v27i2.3327.

  PMID: 19489412 BACKGROUND

• Afulani PA, Kirumbi L, Lyndon A. What makes or mars the facility-based childbirth experience: thematic analysis of women's childbirth experiences in western Kenya. Reprod Health. 2017 Dec 29;14(1):180. doi: 10.1186/s12978-017-0446-7.

  PMID: 29284490 BACKGROUND

• Afulani PA, Moyer C. Explaining Disparities in Use of Skilled Birth Attendants in Developing Countries: A Conceptual Framework. PLoS One. 2016 Apr 22;11(4):e0154110. doi: 10.1371/journal.pone.0154110. eCollection 2016.

  PMID: 27105309 BACKGROUND

• Fahy K. What is woman-centred care and why does it matter? Women Birth. 2012 Dec;25(4):149-51. doi: 10.1016/j.wombi.2012.10.005. No abstract available.

  PMID: 23177665 BACKGROUND

• Pope R, Graham L, Patel S. Woman-centred care. Int J Nurs Stud. 2001 Apr;38(2):227-38. doi: 10.1016/s0020-7489(00)00034-1.

  PMID: 11223063 BACKGROUND

• Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for women using routine intrapartum services: a systematic review. Reprod Health. 2018 Feb 6;15(1):23. doi: 10.1186/s12978-018-0466-y.

  PMID: 29409519 BACKGROUND

• Rubashkin N, Warnock R, Diamond-Smith N. A systematic review of person-centered care interventions to improve quality of facility-based delivery. Reprod Health. 2018 Oct 10;15(1):169. doi: 10.1186/s12978-018-0588-2.

  PMID: 30305129 BACKGROUND

• Abuya T, Ndwiga C, Ritter J, Kanya L, Bellows B, Binkin N, Warren CE. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. BMC Pregnancy Childbirth. 2015 Sep 22;15:224. doi: 10.1186/s12884-015-0645-6.

  PMID: 26394616 BACKGROUND

• Familoni OB. An overview of stress in medical practice. Afr Health Sci. 2008 Mar;8(1):6-7. No abstract available.

  PMID: 19357725 BACKGROUND

• Yeboah MA, Ansong MO, Antwi HA, Yiranbon E, Anyan F, Gyebil F. Determinants of Workplace Stress among Healthcare Professionals in Ghana: An Empirical Analysis. ResearchGate. 2014 Mar 1;Vol. 5(No. 4 [Special Issue]):140-151.

  BACKGROUND

• Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA, Greenwald AG, Inui TS. The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012 May;102(5):979-87. doi: 10.2105/AJPH.2011.300558. Epub 2012 Mar 15.

  PMID: 22420787 BACKGROUND

• Nosek BA, Ranganath KA, Smith CT, Chugh D, Olson KR, Lindner NM, Greenwald AG, Devos T, Banaji M, Smyth FL, Hansen JJ. Pervasiveness and Correlates of Implicit Attitudes and Stereotypes. 2007 [cited 2016 Dec 8]; Available from: https://dash.harvard.edu/handle/1/2958438

  BACKGROUND

• Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011 Spring;15(2):71-8. doi: 10.7812/TPP/11.979.

  PMID: 21841929 BACKGROUND

• Major B, Mendes WB, Dovidio JF. Intergroup relations and health disparities: a social psychological perspective. Health Psychol. 2013 May;32(5):514-24. doi: 10.1037/a0030358.

  PMID: 23646834 BACKGROUND

• Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013 Nov;28(11):1504-10. doi: 10.1007/s11606-013-2441-1. Epub 2013 Apr 11.

  PMID: 23576243 BACKGROUND

• McEwen BS. Stressed or stressed out: what is the difference? J Psychiatry Neurosci. 2005 Sep;30(5):315-8.

  PMID: 16151535 BACKGROUND

• Public Health England. Interventions to prevent burnout in high risk individuals: evidence review - Publications - GOV.UK [Internet]. 2016 [cited 2016 Oct 26]. Available from: https://www.gov.uk/government/publications/interventions-to-prevent-burnout-in-high-risk-individuals-evidence-review

  BACKGROUND

• Halbesleben JRB, editor. Handbook of Stress and Burnout in Health Care. 3 edition. New York: Nova Science Pub Inc; 2008.

  BACKGROUND

• Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009 Nov 14;374(9702):1714-21. doi: 10.1016/S0140-6736(09)61424-0.

  PMID: 19914516 BACKGROUND

• Klein J, Grosse Frie K, Blum K, von dem Knesebeck O. Burnout and perceived quality of care among German clinicians in surgery. Int J Qual Health Care. 2010 Dec;22(6):525-30. doi: 10.1093/intqhc/mzq056. Epub 2010 Oct 8.

  PMID: 20935011 BACKGROUND

• Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009 Sep 23;302(12):1284-93. doi: 10.1001/jama.2009.1384.

  PMID: 19773563 BACKGROUND

• Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003 Apr 15;114(6):513-9. doi: 10.1016/s0002-9343(03)00117-7. No abstract available.

  PMID: 12727590 BACKGROUND

• Khalil D. Violence against midwives in Cape Town. Afr J Midwifery Womens Health. 2009 Feb 1;3(1):37-40.

  BACKGROUND

• Fauveau V, Sherratt DR, de Bernis L. Human resources for maternal health: multi-purpose or specialists? Hum Resour Health. 2008 Sep 30;6:21. doi: 10.1186/1478-4491-6-21.

  PMID: 18826600 BACKGROUND

• Afulani PA, Kelly AM, Buback L, Asunka J, Kirumbi L, Lyndon A. Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya. Health Policy Plan. 2020 Jun 1;35(5):577-586. doi: 10.1093/heapol/czaa009.

  PMID: 32154878 BACKGROUND

• Mendes WB, Koslov K. Brittle smiles: positive biases toward stigmatized and outgroup targets. J Exp Psychol Gen. 2013 Aug;142(3):923-33. doi: 10.1037/a0029663. Epub 2012 Aug 13.

  PMID: 22889160 BACKGROUND

• Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, Banaji MR. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007 Sep;22(9):1231-8. doi: 10.1007/s11606-007-0258-5. Epub 2007 Jun 27.

  PMID: 17594129 BACKGROUND

• Sabin JA, Greenwald AG. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012 May;102(5):988-95. doi: 10.2105/AJPH.2011.300621. Epub 2012 Mar 15.

  PMID: 22420817 BACKGROUND

• Turan JM, Hatcher AH, Medema-Wijnveen J, Onono M, Miller S, Bukusi EA, Turan B, Cohen CR. The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. PLoS Med. 2012;9(8):e1001295. doi: 10.1371/journal.pmed.1001295. Epub 2012 Aug 21.

  PMID: 22927800 BACKGROUND

• Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study. AIDS Behav. 2011 Aug;15(6):1111-20. doi: 10.1007/s10461-010-9798-5.

  PMID: 20827573 BACKGROUND

• Tincher MM, Lebois LA, Barsalou LW. Mindful attention reduces linguistic intergroup bias. Mindfulness (N Y). 2016 Apr;7(2):349-360. doi: 10.1007/s12671-015-0450-3. Epub 2015 Oct 15.

  PMID: 27200110 BACKGROUND

• Devine PG, Forscher PS, Austin AJ, Cox WT. Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. J Exp Soc Psychol. 2012 Nov;48(6):1267-1278. doi: 10.1016/j.jesp.2012.06.003.

  PMID: 23524616 BACKGROUND

• Clarke AE. Situational Analysis: Grounded Theory After the Postmodern Turn. 1 edition. Thousand Oaks, Calif: SAGE Publications, Inc; 2005.

  BACKGROUND

• Lateef F. Simulation-based learning: Just like the real thing. J Emerg Trauma Shock. 2010 Oct;3(4):348-52. doi: 10.4103/0974-2700.70743.

  PMID: 21063557 BACKGROUND

• Sally S. Russell. An Overview of Adult Learning Processes [Internet]. Medscape. [cited 2016 Nov 7]. Available from: http://www.medscape.com/viewarticle/547417

  BACKGROUND

• Bloom SL. Organizational Stress and Trauma-Informed Services. In: Levin BL, Becker MA, editors. Public Health Perspect Womens Ment Health [Internet]. Springer New York; 2010 [cited 2016 Dec 6]. p. 295-311. Available from: http://link.springer.com/chapter/10.1007/978-1-4419-1526-9_15

  BACKGROUND

• Proctor EK, Powell BJ, Baumann AA, Hamilton AM, Santens RL. Writing implementation research grant proposals: ten key ingredients. Implement Sci. 2012 Oct 12;7:96. doi: 10.1186/1748-5908-7-96.

  PMID: 23062065 BACKGROUND

• Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011 Mar;38(2):65-76. doi: 10.1007/s10488-010-0319-7.

  PMID: 20957426 BACKGROUND

• Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007 Nov 30;2:40. doi: 10.1186/1748-5908-2-40.

  PMID: 18053122 BACKGROUND

• Breitenstein SM, Gross D, Garvey CA, Hill C, Fogg L, Resnick B. Implementation fidelity in community-based interventions. Res Nurs Health. 2010 Apr;33(2):164-73. doi: 10.1002/nur.20373.

  PMID: 20198637 BACKGROUND

• Rossi PH, Lipsey MW, Freeman HE. Evaluation: A systematic approach. 7th ed. Thousand Oaks, CA: Sage Publications, Inc.; 2004:68-81.

  BACKGROUND

• Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96. No abstract available.

  PMID: 6668417 BACKGROUND

• Gerber M, Colledge F, Mucke M, Schilling R, Brand S, Ludyga S. Psychometric properties of the Shirom-Melamed Burnout Measure (SMBM) among adolescents: results from three cross-sectional studies. BMC Psychiatry. 2018 Aug 25;18(1):266. doi: 10.1186/s12888-018-1841-5.

  PMID: 30144799 BACKGROUND

• Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature. Psychiatry Investig. 2018 Mar;15(3):235-245. doi: 10.30773/pi.2017.08.17. Epub 2018 Feb 28.

  PMID: 29486547 BACKGROUND

• Jarvelin-Pasanen S, Sinikallio S, Tarvainen MP. Heart rate variability and occupational stress-systematic review. Ind Health. 2018 Nov 21;56(6):500-511. doi: 10.2486/indhealth.2017-0190. Epub 2018 Jun 16.

  PMID: 29910218 BACKGROUND

• Lennartsson AK, Jonsdottir I, Sjors A. Low heart rate variability in patients with clinical burnout. Int J Psychophysiol. 2016 Dec;110:171-178. doi: 10.1016/j.ijpsycho.2016.08.005. Epub 2016 Aug 14.

  PMID: 27535344 BACKGROUND

• Russell E, Koren G, Rieder M, Van Uum S. Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions. Psychoneuroendocrinology. 2012 May;37(5):589-601. doi: 10.1016/j.psyneuen.2011.09.009. Epub 2011 Oct 4.

  PMID: 21974976 BACKGROUND

• Sauve B, Koren G, Walsh G, Tokmakejian S, Van Uum SH. Measurement of cortisol in human hair as a biomarker of systemic exposure. Clin Invest Med. 2007;30(5):E183-91. doi: 10.25011/cim.v30i5.2894.

  PMID: 17892760 BACKGROUND

• Afulani PA, Diamond-Smith N, Golub G, Sudhinaraset M. Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reprod Health. 2017 Sep 22;14(1):118. doi: 10.1186/s12978-017-0381-7.

  PMID: 28938885 BACKGROUND

• Afulani PA, Buback L, Kelly AM, Kirumbi L, Cohen CR, Lyndon A. Providers' perceptions of communication and women's autonomy during childbirth: a mixed methods study in Kenya. Reprod Health. 2020 Jun 3;17(1):85. doi: 10.1186/s12978-020-0909-0.

  PMID: 32493424 BACKGROUND

• Lane, K. A., Banaji, M. R., Nosek, B. A. & Greenwald, A. G. Understanding and Using the Implicit Association Test: IV: What We Know (So Far) about the Method. in Implicit measures of attitudes (eds. Wittenbrink, B. & Schwarz, N.) 59-102 (Guilford Press, 2007).

  BACKGROUND

• About the IAT. Available at: https://implicit.harvard.edu/implicit/iatdetails.html.

  BACKGROUND

MeSH Terms

Conditions

Psychological Well-Being; Stress, Psychological; Burnout, Psychological; Social Discrimination; Bias, Implicit; Prejudice

Condition Hierarchy (Ancestors)

Personal Satisfaction; Behavior; Behavioral Symptoms; Social Behavior

Limitations and Caveats

Our initial plan was to use 14 and 17 items for assessing stress and bias knowledge and attitudes respectively, but the final analysis used 13 and 15 items- 3 questions did not perform well during pretesting. Change in Hair Cortisol Levels includes for analysis the total number of participants we were able to collect hair samples with- 15 and 7, for intervention and control, respecively. Change in Heart Rate Variability (HRV) Levels were limited to those who consented and provided HRV data.

Results Point of Contact

• Title: Dr. Patience Afulani
• Organization: University of California, San Francisco

Patience.Afulani@ucsf.edu

(415) 476-1000

Study Officials

• Patience Afulani, PhD, MD, MPH

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 18, 2021
• First Posted: August 24, 2021
• Study Start: August 16, 2021
• Primary Completion: June 24, 2022
• Study Completion: August 31, 2023
• Last Updated: May 7, 2025
• Results First Posted: June 12, 2024

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

KE (1)