74 - Approaches to Measuring Capacity to Address Health Equity in a Maternal Health Workforce Setting

Abstract Information:

Purpose: Presenters will engage the audience in discussion on best practices for measuring capacity to address maternal health equity.

Background: Created in 2019, Maternal Health Learning and Innovation Center (MHLIC) is a national center of collaborating organizations funded by the Health Resources and Services Administration (HRSA), dedicated to improving maternal health and maternal health equity through capacity building, collaboration, and a rich resource repository. Along with MHLIC, HRSA also funded 9 State Maternal Health Innovation (MHI) projects and 3 Rural Maternity and Obstetrics Management (RMOMS) programs, which MHLIC is charged to support. African American and American Indian women experience a higher risk of dying from pregnancy-related complications, due to stark racial, ethnic, and geographic disparities in adverse maternal health outcomes among the U.S. Therefore, MHLIC is committed to centering equity in our work. To improve outcomes for all, we commit to particularly focusing on efforts to support those who have been (and still are) historically marginalized and are consequently made most at risk for maternal mortality and morbidity. MHLIC uses evaluation and continuous reflection to improve our services and measure our progress. As part of the evaluation, we want to understand if and how MHLIC contributes to improved capacity among maternal health stakeholders to address health equity and implement innovations in maternal health.

Methods: We began with a baseline learning survey in 2020 of 58 staff members from the State MHI and RMOMS teams to understand how to best meet their learning goals and use that to inform our services in the first two years. The baseline learning survey asked participants to rate their confidence in their team’s ability to address different maternal health topics on a Likert scale. We followed up with a midline learning survey in 2022 with 73 staff from the same teams to: (1) identify the awardees’ strengths and gaps related to maternal health knowledge and skills to inform the capacity building that MHLIC provides, and (2) measure any impact MHLIC’s services may have had on awardees’ capacity to address maternal health. In 2022, we also conducted in-depth interviews with 37 staff from State MHI and RMOMS teams to assess progress towards meeting the program objectives, satisfaction with MHLIC services and impact of MHLIC technical assistance and trainings to improve outcomes. Findings: Results from our 2022 midline survey did not show a clear pattern of increases in awardees’ confidence in their team’s ability across maternal health content areas from baseline to midline (a 2-year period). However, qualitative responses indicate that MHLIC resources have supported their team’s work and generally improved capacity. Interviews indicate the training, coaching, and peer-learning offerings are valued by maternal health stakeholders who appreciate the emphasis on equity. Additionally, qualitative results indicate early signs of improved capacity and translation into practice.

Discussion: Evaluators may consider effective approaches to measure capacity building to address health equity including the benefits and limitations of different data collection approaches and data sources to measure capacity in the maternal health workforce.

Relevance Statement: As noted in the abstract, U.S. African American and American Indian women experience a higher risk of dying from pregnancy-related complications and morbidity. These differences in outcomes are a result of longstanding structural barriers and inequitable access to quality maternal care. To improve these outcomes, evaluators can play an important role in the effort to eliminate disparities by assessing needs, documenting challenges and improvements, and telling the story of effective approaches to improve health equity. Our process of continuous learning and disseminating our findings may be valuable to the evaluators conducting similar evaluations in other public health settings in pursuit of a more equitable and just society.