The overall purpose of this research project is to understand and identify priorities to improve the occupational climate among physicians in the University of Kentucky College of Medicine with regard to their experience of stress, career satisfaction, and perceived diversity, equity, and inclusivity (DEI). We will compare and contrast stress, satisfaction, and perceived DEI of UK by physician race (i.e., white vs. non-white) and examine physician perspectives on strategies to recruit and retain more diverse physicians at UK.  To accomplish this, we plan to conduct a ~10-minute, one-time, anonymous online survey of 200 physician faculty at UK.  Physicians will be recruited through existing UK listservs. Results of this study will inform priorities for initiatives to improve career satisfaction and occupational wellness among UK physicians, particularly among underrepresented minority physicians. Results will also inform priorities for policy reform and program development to achieve a more diverse, equitable, and inclusive workforce. This research is not only timely, but essential for both the current and aspiring physician population.

Research has shown that Black women are three to four times more likely to die of pregnancy-related causes than White women. Because Black women, on average, have more chronic conditions, physicians may need to spend more time with them to ensure they are not showing symptoms of severe pregnancy-related conditions. Enlisting certified nurse-midwives to bridge the gap between patient and physician may be beneficial. However, little is known about the acceptability of nurse-midwife care among African American women. To address this gap in the literature, this study will observe Black women’s acceptability of utilizing nurse-midwives as part of their care by examining their knowledge of and attitudes towards nurse-midwife care by conducting online surveys with Black women of childbearing age who are pregnant, have been pregnant, or plan to be pregnant. Participants will be recruited from medical clinics and community organizations in Fayette County (n = 75). Analysis will focus on examining (1) sociodemographic factors that are associated with greater knowledge of and the acceptability of nurse-midwife care; and (2) examining how women’s first-hand experience and awareness by word-of-mouth through their social networks of positive and negative interactions with medical providers are associated with the acceptability of nurse-midwife care.

The purpose of this project is to investigate vaccine hesitancy in relation to the COVID-19 pandemic, and how, more specifically, social and structural barriers to vaccine access and medical mistrust may impact equitable vaccination rates in African American individuals who reside in the southern United States. Current research shows that 46% of participants in a similar study expressed uncertain or low intent to receive the COVID-19 vaccine with factors such as Black race, distrust in the efficacy of vaccines, and residence within a community with a higher area deprivation index (ADI) influencing intentions most strongly. This study will analyze data from the Southern Community Cohort Study, a prospective cohort of approximately 85,000 adults in the southeastern United States (including AL, AR, FL, GA, KY, LA, MO, NC, SC, TN, VA, and WV) to examine demographics, health information and behaviors, and social and structural barriers as they relate to vaccine hesitancy. Results of this study will be presented at scientific conferences and distributed to members of the Lexington, KY community through outreach events. The results of this study will be used to inform ongoing vaccination outreach efforts related to COVID-19, as well as to increase vaccination rates for other viruses, including the influenza virus and Orthopoxvirus. These results will be shared with community stakeholders to guide other dissemination efforts and begin to mend the relationship between communities of color and the field of medicine.

Kids Count data from 2021 provides information that Black and Latinx children, along with and children of two or more ethnicities/races have lower rates of health insurance than White populations in Kentucky. In addition, data from The March of Dimes shows that infant mortality rates were increased for Black and Latinx populations in Kentucky when compared to White populations in 2017-2019. The data suggests that Black and Latinx children in Kentucky are less likely to be insured than White children. Additionally, Black and Latinx children experience higher rates of infant mortality and low-birth weight than White children. The purpose of this study is to evaluate which medical resources for children are used by Black and Latinx families in Lexington, Kentucky and determine what actions could be taken to overcome possible barriers to access.  An anonymous, one time, approximately 10 question survey including questions on common ailments, access to health resources, and barriers faced will be distributed to parents and guardians of children in Lexington at community events hosted by the Lexington Leadership Foundation. Results of this study will be used to describe the current state of health care access and to develop resources to improve the health of ethnically/racially diverse children in Lexington.  

Research has shown that the physician-patient relationship is negatively impacted by biases and mistreatment of Black Americans and immigrants in healthcare. Racial and ethnic biases can lead to health disparities for underserved populations. The first step in eliminating health disparities within the healthcare system is addressing the social determinants of health (SDOH). The primary goal of this study is to determine existing health inequities and SDOH that may impact quality health care for families located within a low socioeconomic area in southcentral Kentucky. One adult from each household will receive a modified version of the American Academy of Family Physicians (AAFP) questionnaire used to screen participants for existing social determinants that may impact their health outcomes. The questionnaire offers the ability to present evidence-based findings to support improved healthcare and healthcare initiatives within the community. In order to improve the quality of health care, it is imperative to understand how SDOH and health inequity affects diverse patient populations.

In 2020, 861 women died of maternal causes in the United States. The mortality rate of black women was 2.9 times greater than non-Hispanic white women. Black women are more likely to die during childbirth compared to their white counterparts—this is regardless of education, income, or any other socioeconomic factors. This disparity can be due to increased prevalence of chronic diseases, patient/doctor interactions, and the “weathering hypothesis.” 
Nonetheless, research shows that implicit bias can also contribute to this health disparity. Implicit bias is a type of bias that occurs automatically and unintentionally and can affect judgments, decisions, and behaviors—this can be manifested through lack of knowledge and awareness. One way to eliminate these biases and improve patient care is to introduce a culturally competent learning module to third-year medical students to assess their knowledge on black maternal mortality and morbidity. This will be done during the OB/GYN rotation orientation in which students will take a pre-quiz assessing their baseline knowledge, complete a module about black maternal health disparities, and a post-quiz to see if knowledge has increased from baseline. Teaching student doctors the causes of this health disparity can improve their understanding and communication with patients, which overall improves patient care. 

In 2020, the US maternal mortality rate was 23.8 deaths per 100,000 live births—this rate is doubled to tripled among non-Hispanic Black, American Indian, and Alaskan Native birthing individuals. Given that the majority of these deaths are preventable, it is important to understand and implement solutions that improve maternal health outcomes, especially among these historically resilient patient populations. The implementation of a disparities dashboard, a tool that stratifies health outcomes by race and ethnicity, payor, and zip code, has been shown to help hospitals and providers monitor and improve upon racial health disparities as they arise. Few studies have evaluated the implementation and impact of a disparities dashboard for maternal morbidity and mortality; thus, this study will use quality improvement guidelines from the Alliance for Innovation on Maternal Health (AIM) to build and disseminate a disparities dashboard among providers within the Department of OBGYN at UKHC. Surveys assessing providers’ knowledge and attitudes towards maternal health disparities and the use of a disparities dashboard, and the impact of implementing the disparities dashboard on these outcomes will be conducted before, during and at the end of the pilot implementation of the dashboard. Results of the surveys (primary outcome) and trends observed in clinical outcomes included in the dashboard (exploratory outcomes) will be used to inform the direction of provider education on health disparities, clinical care of historically resilient patient populations, and policy reform within UKHC and beyond.