Assessing Native Hawaiian and Pacific Islander Maternal Outcomes and Health Care Experiences - PROJECT SUMMARY
The purpose of this K01 award is to support research training and advance the career development of Dr.
Rebecca Delafield. Dr. Delafield’s long-term career goal is to establish an independent research program
focused on improving maternal health and health care outcomes for Native Hawaiian and Pacific Islanders
(NHPI). Research Plan: Maternal mortality and morbidity are increasing in the U.S. A recent study from Hawai‘i
found that NHPI accounted for 44% of the maternal deaths, although they make up only 25% of the state
population. Beyond this single study, NHPI maternal mortality is largely invisible. Federal agencies do not publish
maternal mortality rates of NHPIs. This void is exacerbated by a dearth of research on other major and more
common maternal health outcomes, such as severe maternal morbidity (SMM) (e.g., eclampsia and
hemorrhage). Yet, a small body of research suggests NHPI communities face obstacles accessing the
healthcare system and engaging with health care providers, which may compromise care in pregnancy. NHPI
women may also have unique cultural perspectives on childbearing which could mitigate or exacerbate these
challenges. To comprehensively address maternal health among NHPIs, research is needed to 1) assess critical
maternal outcomes for NHPIs 2) better characterize NHPI experiences, and 3) identify key factors related the
processes and quality of maternity care. There are two research aims: 1) Compare rates of SMM in NHPI women
to non-Hispanic white women by analyzing hospital discharge data from facilities in Hawaiʻi, Oregon, and
Washington. 2) Survey 300 NHPI women to assess patient-clinician relationship and communication factors
associated with high-quality person-centered care, perceived discrimination, and engagement in prenatal care.
Career Plan: This project will provide the candidate the mentoring and training needed in the areas of scientific
and statistical methodologies for small populations, community-engaged research and health communication to
achieve her long-term career goal and short-term objectives. The third (training) aim is: Complete a rigorous
training program to advance skills in small population health research and statistical methods, survey analysis,
and community-engaged research. The Mentoring Team assembled has diverse skills and extensive experience
in the areas of NHPI health, health disparities research, epidemiology, community-engaged research, health
communication, maternal and reproductive health. Training objectives will be met through relevant coursework,
mentored research training, bi-directional training with community-based partners, and hands-on learning
grounded in Pacific cultural traditions. The completion of these aims will provide the candidate the experience
and preliminary data needed to compete for R01 funding as an independent investigator and progress toward
her future goal of developing and testing a culturally-responsive and community-engaged multilevel intervention
to improve NHPI maternal and perinatal health.
