Abstract
Introduction
Implicit bias can lead medical professionals in Neonatal Intensive Care Units (NICUs) to disregard mothers who are Black and economically disadvantaged as they advocate for their infants’ health. Disregard can weaken underlying communication principles within the Family-Centered Care (FCC) model of pediatric health in NICUs and increase maternal distress. This study is the first to address communication disregard by examining mothers’ perceived power and efficacy of voice with NICU doctors and nurses. We hypothesized that mothers who are Black and economically disadvantaged would report lower efficacy of voice and higher levels of distress as compared to White mothers with higher income.
Methods
During pre-assessment within a small clinical trial of a parenting intervention, 33 racially and economically diverse mothers, from three Midwest NICUs serving the urban poor, responded to a 14-item measure of maternal power and efficacy of voice and measures of somatization, depression, anxiety and eating/sleeping disorders. Nonparametric examinations assessed the relation of power and efficacy of voice to maternal race, income, and distress.
Results
In contrast to White, higher-income mothers, Black, economically disadvantaged mothers reported lower perceived efficacy of voice with doctors (U = 74.5, d = 0.65) and nurses (U = 74.0; d = .0.66). These mothers with lower perceived efficacy with doctors and nurses, reported higher levels of somatization (U = 16.5, d = 1.14; U = 13.5, d = 1.38, respectively) and eating disorders (U = 14.0, d = 1.29; U = 12.0, d = 1.48, respectively).
Discussion
Study results are discussed within the framework of implicit bias in FCC in the NICU, expanding our understanding of effective communication with economically stressed, Black mothers.
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Data Availability
The deidentified study dataset is housed securely at the Oregon Research Institute.
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Funding
This work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) and the R40 Maternal and Child Health Field-initiated Innovative Research Studies Program under Grant Number R40MC26822. Content and conclusions herein are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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D and B conceptualized this article; D and B developed the methodology; formal analysis was conducted by D and L. The parent study investigation was conducted B, D and F; grant funding—B, F, D; writing—original draft preparation, D and B; writing—review and editing—D and B, P, L; funding acquisition, B.
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Davis, B., Baggett, K.M., Patterson, A.L. et al. Power and Efficacy of Maternal Voice in Neonatal Intensive Care Units: Implicit Bias and Family-Centered Care. Matern Child Health J 26, 905–912 (2022). https://doi.org/10.1007/s10995-021-03199-z
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DOI: https://doi.org/10.1007/s10995-021-03199-z