# Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care

> **NIH NIH R00** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $243,995

## Abstract

PROJECT SUMMARY/ABSTRACT
This Pathway to Independence Award (K99/R00) will facilitate my transition to an independent scientist who
conducts innovative research on the social, structural, and health system drivers of maternal and child health
(MCH) disparities, and translates the findings into practical interventions that will reduce disparities and
improve MCH outcomes. The activities described in this proposal are aimed at addressing health care provider
stress and unconscious bias to improve quality of maternal health care, particularly the person-centered
dimensions. Poor person-centered maternal health care (PCMHC) contributes to high maternal and neonatal
mortality in sub-Saharan Africa (SSA), and disparities in PCMHC are driving disparities in use of maternal
health services. Little research, however, exists on how to improve PCMHC and reduce disparities. I seek to fill
this gap with this project. I propose targeting health provider stress and unconscious bias as fundamental
factors driving poor PCMHC and disparities in PCMHC. Health provider stress and unconscious bias are
important to consider because: (1) providers in low-resource settings often work under very stressful
conditions; (2) unconscious bias is prevalent in every society including SSA; and (3) these factors are mutually
reinforcing drivers of poor quality care and disparities in person-centered care. To prepare me to develop my
unique research program and extend the evidence base on interventions to improve PCMHC, I propose
training and research during the mentored phase (K99) to extend my knowledge and skills in: (1) stress and
unconscious bias; (2) advanced qualitative and mixed methods research; and (3) implementation science
methodology. In the K99 phase, I will also conduct (1) multilevel secondary data analysis to examine individual
level characteristics and potential system level stressors associated with PCMHC, focusing on the role of
provider stress; and (2) structured and in-depth interviews with providers to examine the levels of provider
stress and unconscious bias, and the types of stressors and biases in Kenya. The knowledge and skills gained
in the mentored phase, as well as the results of the mentored research, will be instrumental to achieving the
aims of the independent phase (R00), which are to: (1) design a multicomponent theory and evidence-based
intervention that enables providers to identify and manage their stress and unconscious bias; (2) pilot the
intervention to assess its feasibility and acceptability; and (3) assess preliminary effect of the intervention on:
(a) provider knowledge, attitudes, and behaviors related to stress and unconscious bias; and (b) provider
stress levels—using a pretest-posttest control group design. I will use the results of the pilot to refine the
intervention and develop an R01 proposal for a multi-site evaluation with a larger sample and longer follow up,
to assess impact on PCMHC. My mentorship and consulting team is un...

## Key facts

- **NIH application ID:** 10466779
- **Project number:** 5R00HD093798-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Patience A Afulani
- **Activity code:** R00 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $243,995
- **Award type:** 5
- **Project period:** 2020-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10466779

## Citation

> US National Institutes of Health, RePORTER application 10466779, Addressing Provider Stress and Unconscious Bias to Improve Quality of Maternal Health Care (5R00HD093798-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10466779. Licensed CC0.

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