Implementation Barriers to Incorporating a Community-Based Doula Program to Improve Birth Outcomes for Black Patients in an Academic Medical Center. J Racial Ethn Health Disparities 2025 Apr 16
Date
04/16/2025Pubmed ID
40237955Pubmed Central ID
PMC12353627DOI
10.1007/s40615-025-02444-3Scopus ID
2-s2.0-105002729893 (requires institutional sign-in at Scopus site)Abstract
There are significant racial disparities in maternal health and birth outcomes in the USA that disproportionately affect Black individuals. Incorporating community-based doula programs into hospital settings may be an effective intervention to reduce these disparities. However, little research has examined potential barriers and identified strategies to optimize the implementation of a community-based doula program in an academic hospital setting. This study used in-depth interviews with clinicians and nurses (n = 19) and focus groups with doulas (n = 11) to identify multi-level barriers to implementing a doula program for Black pregnant patients in a single academic hospital setting in Milwaukee, WI. Data were analyzed using thematic analysis, and we developed four themes that highlight potential implementation barriers: (1) doulas' advocacy efforts were met with resistance from the healthcare team; (2) there was a lack of trust and established relationships between doulas, clinicians, and nurses; (3) there was a hierarchy of knowledge within medical settings that diminished the value of doulas' expertise; and (4) system-level barriers prevented sustained integration of doula programs. Despite the promise of community-based doula programs, significant investment and resources are needed to support implementation and ensure sustainability.
Author List
Quinn KG, Marion E, Williams JS, Blackwell D, Olson J, Palatnik AAuthors
Jessica Olson PhD Director, Associate Professor in the Institute for Health and Humanity department at Medical College of WisconsinAnna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Katherine Quinn PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Joni Williams MPH, MD Center Director, Associate Professor in the Medicine department at Medical College of Wisconsin
