- Black and African American patients face well-documented disparities during pregnancy and delivery.
- Partnerships with culturally specific programs are one strategy that health systems use to respond to those disparities.
- A study by Providence CORE and Dr. Roberta Hunte interviewed clients of one such program to help understand their experiences. This blog post shares three key findings.
Despite improvements in recent decades, pregnant Black and African American patients and their babies are much more likely to die or become ill during pregnancy or delivery than their White counterparts.
Past research has shown that culturally specific programs offering guidance and support around pregnancy can help by addressing a key driver of these disparities: structural racism and related chronic stress that patients experience during healthcare.
As more health systems partner with culturally specific organizations, patient voices are key to shaping more effective programs. New research from the Providence Center for Outcomes Research & Education (CORE) and Dr. Roberta Hunte of Portland State University offers lessons from one such program. Read on for three key takeaways from their study.
Studying a health system-culturally specific program partnership
Healthy Birth Initiatives (HBI) in Multnomah County, Oregon, provides support for Black and African American patients from pregnancy through their child’s 18th month. Services include in-home case management, nurse home visits, and mental health support. The Providence health system and HBI have partnered for nearly 10 years to support patients and strengthen Providence’s maternal and child health practices and policies.
Prior research by CORE and Dr. Hunte looked at staff views on this partnership. This study centers on Providence patients engaged with HBI. Eight in-depth patient interviews were coded and analyzed using advanced qualitative methods.
“This study reinforces what many in maternal health already know: culturally specific programs like HBI can make a real difference for Black patients and their babies. To realize the full benefits of these partnerships, health systems must listen to patient and partner voices, ensure better coordination, and invest in consistent, culturally sensitive care” - CORE Research Scientist Monique Gill, PhD, MPH,
Centering patient voices: Three key findings
1. Increasing provider diversity improves patient experiences
Participants were grateful for HBI’s wraparound support. However, they described difficulties finding a healthcare provider who understood their needs and cultural background. Some sought out culturally specific providers. Others cycled through several before finding a good fit.
These experiences underscore the well-known need for health systems to increase provider diversity. “Addressing Black provider shortages through education, policy, and institutional efforts is vital to improving care quality, especially in prenatal settings,” explains Gill.
2. Patients benefit from consistent and culturally sensitive care and support
One thing that came through clearly in the interviews was that navigating pregnancy along with other challenges felt isolating for patients. HBI provided someone to talk to and help navigate care. They also connected patients to resources during that vulnerable time. In participants' words, HBI’s non-judgmental and inviting approach made them feel “safe and connected” instead of “scared and alone.”
Yet patients still desired a consistent, culturally concordant medical provider. And some described how negative past healthcare experiences shaped how they viewed and engaged with care. Feeling comfortable with providers, having time to ask questions, and not being treated as just another patient all mattered deeply.
These points highlight the value patients place on stable relationships with providers, and the role HBI played in bridging gaps in support. HBI’s services helped foster communication, trust, and understanding, leading to better experiences and outcomes described by patients.
3. Proactive support and smooth referrals are crucial
While participants appreciated the extra support, many wanted smoother referrals and more proactive help. Inconsistent contact information and gaps between the two partners left some patients feeling they had “fallen through the cracks.” They also wanted stronger alignment between the two partners around patient care.
These findings underscore the need for clear coordination between health systems and their community partners. Gill suggests that “strong integration program staff with health system care teams and health system investments in areas like coordination could improve the overall quality of pregnancy care.”
From patient voices to lasting change
This study shows that culturally specific partners like HBI can make a meaningful difference for patients. Achieving these programs’ full potential will require health systems to listen to patient voices, improve coordination, and commit to culturally sensitive care.
By centering patients in design and delivery, health systems and community programs can close gaps and advance more equitable care.
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