Jennifer Marshall

Background: Respectful maternity care is an important factor in addressing maternal health outcomes; however, stark differences persist among maternal populations. Examining respectful maternity care experiences of postpartum individuals can inform strategies to address gaps in healthcare delivery and outcomes. This study explores postpartum individuals' experiences with respectful maternity care and identifies gaps in maternity care delivery in Florida. Methods: This qualitative study used thematic analysis of semi‐structured in‐depth interviews conducted via videoconferencing or telephone from June 26 to August 25, 2023. Participants were recruited from Healthy Start Coalitions across Florida. Participants included 163 postpartum individuals from diverse backgrounds who were at least 18 years old, spoke English, Spanish, or Haitian Creole, and had given birth in Florida within the last year. The primary outcomes were participants' overall scores of their birth experience and described experiences of respectful maternity care. Key themes related to respectful maternity care during the birthing hospital stay were identified. Results: Participants from 37 counties had given birth in one of 42 hospitals. On average, participants were 2.8 months postpartum, with a mean age of 29.5 years, and were racially and ethnically diverse—35.6% Black/AA, 32.5% Hispanic, and 31.3% White. Participants rated their overall hospital birth experience an average of 8.8 out of 10, indicating a very good experience. Four major themes emerged, highlighting gaps and differences in respectful maternity care: (1) discrimination (racial discrimination, age, race, and socioeconomic status, and immigration status); (2) consent (provision of comprehensive health‐related information to consent, and lack of consent in patient's primary language); (3) patient‐provider communication (consistency, adequacy, and clarity of information given by healthcare providers, active listening and interactional tone, and language barriers); and (4) respect for patients' choices (engagement in shared decision‐making, provision of sufficient pain management, and provision of comprehensive lactation support). Conclusion: This study identified discrepancies in respectful maternity care experiences among postpartum individuals, emphasizing the need to address these gaps. Findings support the development and implementation of quality improvement interventions targeted at improving respectful maternity care to ensure high‐quality, patient‐centered maternity care for all patients.

Objective: Florida’s public health workforce faced unprecedented challenges during the compounding COVID-19 pandemic and record-setting hurricane seasons. The objective of this study was to understand burnout within this essential workforce and identify strategies to better support them. Methods: A cross-sectional survey addressing burnout, job satisfaction, turnover intention, job demands, job resources, and organizational support in 2021 was completed by 891 Florida Department of Health workers and analyzed by the research team. Results: Approximately half of the respondents reported experiencing burnout, which is linked to job dissatisfaction and turnover intention. Strategies to effectively support and retain this essential workforce include improving staffing, salaries, flexibility, trainings, resources, and leadership. Conclusions: As infectious disease outbreaks and extreme weather events continue to occur, effectively supporting the public health workforce is critical to protecting and promoting the health and well-being of all Floridians.

Objectives The first 5 years of life are critical to children’s health and development. Sociocultural and environmental factors play a prominent role as do variations in the quality of resources available. The objective of this study, grounded in Asset Based Community Development and the Model of Children’s Health and its Influences, was to identify and understand these factors through the lens of parents living in predominantly African-American low-income communities within Washington, DC. Methods An exploratory qualitative study employed semi-structured virtual interviews to discuss parents’ priorities and challenges in raising their children. Results Participants relayed perceptions of community assets as well as struggles with access to care, proper nutrition, and police activity within their communities. Results were presented to apprise community partners and encourage modifications in program delivery to enhance community resources. Conclusions for Practice Lived experiences voiced by underrepresented parents can potentially inform design of community-centered programing. Policymakers must take into account community strengths and weaknesses during the development of community services. Due to inequities in childhood health outcomes, it is imperative that policymakers receive information from parents to make informed decisions.

Background and Objective: Coronavirus 2 (SARS-CoV-2), a novel respiratory virus, rapidly spread, and placed patients at increased risk for short and potentially long-standing medical illnesses. The pandemic necessitated the rapid implementation of virtual prenatal care via telemedicine in obstetrics to maintain social distancing measures. The aim of this study was to assess and understand the patient perspectives of the rapidly implemented virtual prenatal care via a telemedicine model during the Coronavirus disease 2019 (COVID-19) pandemic utilizing the Consolidated Framework in Implementation Research (CFIR). Methods: Following the implementation of virtual prenatal care in March 2020, pregnant patients at a large urban clinic in the southeastern United States completed a 19-question anonymous survey that included open and closed-ended questions on their experience receiving virtual prenatal care via telemedicine or in-person prenatal care from May to December 2020. The survey and mixed-methods data analysis was guided by the CFIR framework. Results: A total of 59 patients completed the survey. One-third (31%, n=18) of the patients found virtual prenatal care to be an acceptable alternative model, and half (53%, n=31) found it acceptable only during a pandemic, preferring to return to in-person visits. Qualitative analysis found that some patients were deterred by limited in-person examinations and uncertainty with the virtual platform, while others appreciated the reduced need for transportation, childcare, and time spent. Conclusion and Global Health Implications: Most patients found virtual prenatal care to be easy to access and an acceptable alternative during the pandemic; however, most would prefer to return to in-person prenatal care visits. Future comparative research studies should examine how, among others, virtual prenatal care versus in-person prenatal care impacts specific maternal and fetal outcomes.

Early Childhood Comprehensive Systems (ECCS) grants help states and communities improve early childhood systems to support child development, equitable access to quality services and supports, and family well-being. Truly interdisciplinary, ECCS promotes cross-sector systems change initiatives that focus on integrating health care, mental health, social services, and family support broadly and within communities with concentrated risk factors that negatively impact child health and development. Florida was 1 of 12 states funded from 2016 to 2021 to use a Collaborative Improvement and Innovation Network (CoIIN) approach to do this work. Through community-driven initiatives that focus on policy, partnerships, and practices, Florida ECCS committed to ensuring equitable opportunities for families and young children who may face barriers due to residing in disenfranchised communities. This article describes the process of evaluating this multiyear community-led, place-based initiative that leveraged cross-sector state-level support and used a variety of methods to track evolving ECCS processes and outcomes.

Objectives To inform updates to the Pregnancy Risk Assessment Monitoring System (PRAMS) design and processes, African American/Black and Hispanic/Latina women in Florida provided feedback on their awareness and perceptions of the PRAMS survey, and preferences for survey distribution, completion, design and content. Methods Focus groups were conducted in English and Spanish with 29 women in two large metropolitan counties. Participants completed a brief survey, reviewed the PRAMS questionnaire and recruitment materials, engaged in discussion, and gave feedback directly onto cover design posters. Results Participants reported limited awareness of PRAMS. Preferences for survey distribution and completion varied by participant lifestyle. Interest in topics covered by PRAMS was as a motivator for completion, while distrust and confidentiality concerns were deterrents. Participants were least comfortable answering questions about income, illegal drug use, and pregnancy loss/infant death. Changes to the length of the survey, distribution methods, and incentives/rewards for completion were recommended. Conclusions for Practice Results highlight the need to increase PRAMS awareness, build trust, and consider the design, length and modality for questionnaire completion as possible avenues to improve PRAMS response rates.