Inspiring hope, confronting hopelessness: healthcare experiences of Black/African American pregnant and post-partum women and healthcare workers in Detroit, Michigan, U.S.A.

Abstract Background The United States has the highest maternal mortality rate among high-income countries. Black/African American women and infants experience significant disparities in mortality rates. Henry Ford Global Health Initiative implemented a mixed-methods study to explore the association of hopefulness and burn out among healthcare workers (HCWs) and health experiences and outcomes of Black/African American pregnant and post-partum healthcare recipients (HCRs). Methods Quantitative data included demographics and the Herth Hope Index (HHI). Qualitative research included focus groups and individual interviews with HCWs and HCRs from two Henry Ford Health Women’s Health clinics. Prior to data collection, a literature review was completed. Descriptive data and bivariate analysis were completed. Qualitative data used semi-structured interview guides and were audio-taped, transcribed, and coded using Dedoose. Final data tables included codes, sub-themes, and representative quotes. Stakeholder workshops were held in 2020 and 2024. Results Sixty-six HCWs completed the demographic form and HHI. In 2021, 34 (87.2%) HCWs participated in focus groups or interviews and 25 (92.6%) in 2023. Sixty-one HCRs completed the demographic form and HHI and 27 (44.3%) participated in focus groups. On the 48-point HHI scale, HCWs scored 41.7 (SD 4.6) and HCRs scored 40.8 (SD 7.0) indicating a relatively high level of hopefulness. HCW qualitative outcomes included: (1) definitions of hopefulness and hopelessness: (2) personal and work-related sources of care and support; and (3) clinical and systemic challenges and facilitators to meeting patient needs. HCR qualitative outcomes included: (1) definitions of hopefulness and hopelessness; (2) personal, familial, and social sources of care and support; and (3) pregnancy and post-partum healthcare experiences. In 2020, workshop participants generated factors affecting hope in both HCRs and HCWs and potential solutions to reduce burnout and improve pre- and post-partum care for Black/African American women. In 2024, workshop participants reviewed data and prioritized recommendations for interventions. Conclusion This study explored the role of hope as a contributing factor in the experiences of HCWs and Black/African American pregnant and post-partum HCRs. It generated recommendations to address hopelessness and support positive experiences and outcomes. Next steps include identifying resources to pilot and evaluate recommendations at the health system and clinical levels.