Evaluating maternal health capacity building in rural and underserved areas: a research protocol


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Robert W Owens
1 PhD, Evaluation Specialist * ORCID logo

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Thomas Carlyle Whittaker
2 MD, Director Family Medicine Obstetrics Fellowship Program

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Annie Galt
3 BA, Graduate Research Assistant

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Kirsten Stoesser
4 MD, Director Family Medicine Residency Program

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Saskia Spiess
5 MD, Course Director of Family Medicine Residency

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Matthew Jack Mervis
6 BS, Graduate Research Assistant

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Andrew David Curtin
7 MSTAT, Biostatistician

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Elena Gardner
8 BA, Graduate Research Assistant

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Dominik Ose
9 DrPH, Associate Research Professor


1, 2, 3, 4, 5, 6, 7, 8, 9 Department of Family & Preventive Medicine, Division of Family Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108, USA

ACCEPTED: 13 September 2023

early abstract:

Introduction: The USA is currently experiencing a maternal health crisis. Maternal morbidity and mortality in the USA are higher than in other developed nations and continue to rise. Infant mortality, likewise, is higher in the USA than in other developed nations. Limited availability of maternal health services, particularly in rural areas contributes to this crisis. Maternal health outcomes are poorer, and maternal care workforce shortages are more severe in rural areas of the USA. In rural areas where obstetric specialists are rare, many patients rely on Family Medicine physicians for maternity care. However, the number of Family Medicine physicians who provide maternal care services is decreasing, aggravating shortages. Calls have been made to build maternal care capacity in rural areas. The role Family Medicine will play in addressing the maternal health crisis is not clear. Maternal care shortages are complex issues resulting from multiple factors; likewise, efforts to build maternal health capacity are challenging and require multifaceted approaches.
Methods: With funding from the Health Resources and Services Administration (HRSA), the University of Utah seeks to address the shortage of quality maternity care in rural and underserved areas of Utah by strengthening partnerships, enhancing maternal care training of Family Medicine residents and obstetrics fellows, and improving the transition from training to rural practice for residents and fellows. This protocol describes the evaluation of the HRSA-funded project. The evaluation includes three components. Component one consists of qualitative interviews with a diverse group of maternal health providers, administrators, educators and academics, patients, and others. Interviews will be analyzed using qualitative content analysis. Component two is a survey of Family Medicine residents and obstetrics fellows which aims to increase understanding of the factors and circumstances influencing intention to practice in rural or underserved areas and to provide maternal health services. Finally, component three involves surveying fellowship alumni and tracking graduates to assess effectiveness of training programs in producing physicians who provide maternal health services in rural and underserved areas. Surveys will be analyzed with descriptive statistics including means, frequencies, and crosstabulations. If sample size and participation provide sufficient power, statistical tests will be included in analyses.
Conclusions: Evaluation results will help to fill an important gap in research literature concerning outcomes of projects and initiatives designed to build maternal care capacity in rural areas of the USA. In addition, results will provide valuable information regarding effective practices for building capacity which can be adopted elsewhere to address maternal care shortages. Finally, results will help to define the role of Family Medicine in addressing the maternal health crisis. Amid maternal care shortages, fewer and fewer Family Medicine physicians are providing maternal care in their practice. Evaluation results will clarify the role of training and preparation of Family Medicine residents in addressing workforce shortages. This evaluation will provide important contributions, but additional research is needed, including research protocols and studies of project outcomes to understand how best to resolve the maternal care crisis in the USA.