Healthy Futures: 

A Qualitative Study of the Relationship of Perinatal Health Care and Social, Economic and Environmental Conditions to Maternal, Birth and Infant Health Outcomes for African American Women

The Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the University of South Florida is conducting a three year study funded by The Agency for Health Care Administration.  The “Healthy Futures” study will explore personal, social, contextual, and environmental factors that may contribute to adverse maternal, birth, and infant outcomes among African American women in Florida.  The study will also explore protective factors that ameliorate adverse outcomes and contribute to positive birth outcomes.  The information obtained from this study will be provided to the communities involved to assist them in enhancing their perinatal health care systems and to The Agency for Health Care Administration to inform Medicaid reform with respect to perinatal health services and reimbursement policies.

We will conduct two in-depth, face-to-face interviews with African American women one month and six months after the birth of a baby.  English-speaking African American women, regardless of income status, education level, or insurance status who deliver their baby at Bayfront Medical Center, Morton Plant Mease (Clearwater), or Tallahassee Memorial Hospital during the recruitment phase of this study will be invited to take part after having given birth (not before or during labor).  We plan to enroll a total of 440 women in the study; 220 women from the two hospitals in Pinellas county, and 220 women from Tallahassee Memorial Hospital serving the Leon/Gadsden county area.  We expect to lose approximately 10% of initial recruits to follow-up, so we expect to interview a total of 400 women. 

Healthy Families/Healthy Start social workers will recruit eligible women, taking care to be sure they are a resident of one of the three counties of interest (Pinellas, Leon, or Gadsden) and are in the appropriate age range (18 and up to 35 years of age inclusive).  These recruiters will explain the study to each eligible participant and invite her to take part.  Women who agree to take part in the hospital will sign a shortened consent form that affirms their consent to be contacted after they leave the hospital to take part in interviews in their home.  The recruiter will obtain contact information from the woman and give her a storybook for her new baby to thank her for her willingness to participate.  Participants will be told they may decide at any time to decline participation in the study.

We will conduct two interviews with each participant, the first will be held about a month after the birth of the baby, the second will be held when the baby is approximately six months old.  Each interview is expected to be about two hours in length. 

Women taking part in this study will be sharing their impressions of and experiences with the perinatal care system.  All of the interviewers will be trained to build trust with the people they interview and to respect their concerns and responses and avoid any judgmental behavior that might upset the interviewee.  The interviewers will also be trained to defuse any reaction on the part of the interviewee that may result from a sensitive question during the interview so that the interviewee will be supported throughout the process.

Data from the interviews will be transcribed and subject to thematic analysis. Through content analysis, key themes regarding the care women have received, their expectations, wants, and needs about their health care, and their experience with social support and possible discrimination will be identified by the researchers.

 All interviewers will be trained in confidentiality requirements and practices, in the voluntary nature of this study, and in the right of an individual to withdraw from the study at any time.  Study requirements will preclude sharing any information from the interview with anyone beyond the study team, and insure the interviewee that they will not experience any consequences to themselves based on their response or lack thereof to any questions in the interview.  We will periodically monitor the interviewing process to insure that these practices are observed.

The interviewees will be contacted first by the project’s study coordinator within two weeks of their departure from the hospital.  This contact will be to thank the participant for their willingness to be interviewed and to schedule the first interview.  The study coordinator will match an interviewee with an interviewer who is available at a time that is convenient for the interviewee.  The study coordinator will not assign an interviewer to an interviewee if the interviewer has any relationship, professional or otherwise, with the interviewee.  After the first interview, the study coordinator will maintain contact on a monthly basis with all of the participants who agree to be interviewed a second time.  This contact will be through monthly cards reminding the participant that they are still in the study and thanking them for their willingness to participate.  In the fifth month after the birth of the child, the study coordinator will call the participant and schedule the final interview following the same process as used for scheduling the first interview and assigning the interviewee.

The interviewees will receive an incentive upon completion of the interview.  The amount of the incentive will be $20 for the first interview and $20 for the second interview. 

In addition to the interviews with African American women, the research team will conduct a series of listening projects and key informant interviews to obtain the community’s and health care provider’s perspective with regard to the strengths and weaknesses of the existing perinatal health care system. The study will include an analysis of the communities and neighborhoods where participants live to attempt to understand the relationship between social, economic and environmental conditions and maternal, birth and infant health.  Throughout the life of the project and as part of developing its recommendations, the research team will share information and findings with providers and consumers of perinatal health care in each of the counties involved in the study.