“She Resolved My Doubts, and I Was a Little Calmer”: A Qualitative Analysis of the HoPE Community-Based Doula Care Program in an Urban Public Hospital [ID 2683480

Abstract

INTRODUCTION: Doula care, or trained lay birth support, represents an evidence-based and cost-effective strategy to improve maternal and child health. However, limited studies have focused on implementing doula care, especially in racial and ethnic minoritized communities. This study assessed HoPE (Helping Promote Birth Equity through Community-Based Doula Care), an intervention within two Queens, New York, public hospitals. METHODS: This qualitative analysis is part of a mixed-methods evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation science framework (IRB 21-01571). We conducted interviews in English or Spanish with HoPE doula clients (n=13), doulas (n=10), and health care providers (n=8) to assess acceptability, feasibility, and satisfaction. Interviews were audio-recorded, transcribed, and translated (if needed). Multiple coders analyzed themes and developed an analytical narrative. RESULTS: Preliminary findings suggest that HoPE serves a population in critical need of the support offered by community-based doulas. Regarding reach, doula clients were primarily immigrants and first-time mothers with limited social support and financial resources. We observed doula effectiveness in health care navigation, communication with providers, emotional, mental health, and physical support, infant care, health education, and referrals to social resources. Doula clients, doulas, and providers were generally satisfied with the program and found it acceptable and feasible. Implementation challenges, including language capability and timely client matching, hindered reach and effectiveness. CONCLUSION: These preliminary findings demonstrate how community-based doula support can improve health care access and quality of care in diverse, underserved communities. Ongoing evaluation will be used to improve HoPE and contribute to the knowledge of community-centered interventions promoting equity in obstetric care.