Title: Community Racial Equity And Training Interventions and Evaluation of Current and Future Healthcare Clinicians (CREATE) Study Project Summary/Abstract Black women face disproportionately high rates of maternal morbidity and mortality in the United States, both of which are on the rise, in direct contrast to the improved rates globally. Prenatal care has been identified as a way to potentially mitigate these risks, but racism and racial discrimination are barriers to women in accessing prenatal care. The 2019-2023 Trans-NIH Strategic Plan for Women’s Health calls for research that addresses these stark health disparities for women of color. My long-term career goal is lead research to inform interventions that will optimize the reproductive health and wellbeing of Black women. I aim to become a leading investigator applying a reproductive justice framework to understand clinical and structural factors underpinning health adversities experienced by Black women. In this K01 Mentored Research Scientist Development Award, I propose to 1) Refine a racial equity training intervention for prenatal care settings; 2) Pilot test the effects of the racial equity training intervention on clinician outcomes; and 3) Explore the impact of the racial equity training intervention in reducing disparities in adequate care in a sub-sample of Black and white women. I will seek advanced training to support these research goals in 1) intervention development and implementation science, 2) clinical research in cluster randomized designs, and 3) professional skills in project management, leadership, and grantsmanship. These endeavors will benefit from interdisciplinary mentorship from world-renowned scholars including primary mentor Monica McLemore, PhD, MPH, RN, FAAN (clinical obstetric care, racial equity, reproductive justice), and co-mentors Miriam Kuppermann, PhD, MPH (perinatal care models, shared decision-making, professional leadership at UCSF), Charles McCulloch, PhD (biostatistics), and Cynthia Harper, PhD (human centered design and health education). In addition, faculty advisor Andrea Jackson, MD, MAS will provide expertise in prenatal and delivery healthcare settings. The Department of Epidemiology and Biostatistics at the University of California at San Francisco will provide the infrastructure to support these activities. The department made a competitive offer to recruit me into a faculty position in 2018, and departmental leadership is highly committed to my success, providing both resources and protected time. The training and research activities proposed in this K01 build on my strong background in health behavior and racial inequities in reproductive health and give me essential new skills to facilitate my transition to an independent investigator. I aim to lead research using a multi-method approach to understand the mechanisms by which the social ecology produces sexual and reproductive health disparities and to inform interventions to advance Black women’s health.

Project Narrative Black women are 2 to 3 times more likely to have pregnancy-related complications leading to maternal death compared to white women nationwide. In response, the State of California passed two bills requiring that all clinicians receive continuing education courses that address implicit bias and mistreatment in effort to improve the quality of care provided to Black women during pregnancy and delivery. This research will be among the first to refine and pilot test a racial equity training intervention for prenatal care clinicians in effort to improve their implicit racial attitudes and beliefs, increase their awareness of causes of racism and health disparities, and enhance their motivation and self-efficacy to use tools and strategies, thereby shifting the healthcare culture and environment.