PROMOTE and TEACH

Duke University, Durham NC

Investigators

Abstract

ABSTRACT Pregnant patients sometimes face impossible choices between earning necessary income and adherence to prenatal care; these issues were highlighted in our formative qualitative work with Black pregnant patients. Increased prenatal care adherence and positive maternal and infant health outcomes may be promoted by addressing work-related pregnancy care barriers. Obstetric clinicians are uniquely positioned to ensure pregnant patients are educated about federally mandated employment protections during their pregnancy, however very few clinicians have formal training about employment laws that govern accommodations during pregnancy and postpartum. To fill this unmet need, a patient- and community-engaged multidisciplinary team and I developed, and pilot tested PROvider ReMote ObsTetric-Related Employment Education (PROMOTE). Our research aims will use a provider-level randomized trial comparing PROMOTE vs usual care. During Aim 1, we will determine the efficacy of PROMOTE to increase the likelihood that obstetric clinical teams counsel patients about work and pregnancy. In Aim 2, we will determine the effectiveness of PROMOTE to reduce undesired wage or advancement reduction, increase access to accommodations, and improve prenatal care adherence and pregnancy health outcomes. The rich dataset that we will collect, including electronic medical record review, patient survey and qualitative interviews will be leveraged as we develop and pilot test ObsTetric HEAlth Outcomes ResearCH Mentoring (TEACH), a year-long mentored career development and obstetric health disparities research program tailored to medical trainees. A patient- and community-engaged multidisciplinary stakeholder group and I will develop the TEACH mentorship program including career and research mentorship. We will leverage existing institutional resources at Duke and integrate TEACH seamlessly into the unique Duke medical school curriculum which provides a year for mentored research. We will pilot test TEACH with six Duke medical trainees to determine feasibility and acceptability of TEACH. The proposed work is led by an early-stage investigator clinically trained as a Maternal Fetal Medicine subspecialist with master’s level research training, formal health disparities research training, and experience mentoring trainees in medicine. The proposed project integrates research that will yield an intervention that empowers obstetric clinicians with practical skills to address employment-related barriers to prenatal care and work that will develop and pilot testing an obstetric health disparities mentored research experience tailored for medical students.