Perspectives on cultural competency and race concordance from perinatal patients and community‐based doulas

Abstract

Background As awareness of perinatal health disparities grows, many birthing people of color are seeking racially and/or culturally concordant providers. We described preferences for, and perceptions of, racial and/or cultural concordance and cultural competence in the context of the doula–client relationship. Methods Seven focus group discussions (FGDs) with a total of 27 participants were conducted to investigate the perspectives of patients and doulas across Massachusetts, United States. An interdisciplinary stakeholder group informed the data collection instrument content and design. Two coders achieved 0.89 Kappa for inter‐rater reliability prior to coding the remaining transcripts. We used a modified grounded theory approach and Dedoose software for coding. Results Two major themes emerged. First, cultural competency in doula care is a learning process, with definitions consistent with terms such as “cultural humility” and “structural competency.” Doulas discussed listening to clients' needs rather than making assumptions, the importance of understanding privilege and power dynamics, and self‐initiating relevant education beyond formal doula training. Second, trust was most frequently cited as an indicator of successful doula–patient relationships. Conclusions Most study participants specified the importance of cultural humility in doula–client relationships. Doulas approaching the relationship humbly with a willingness to learn and challenge their own assumptions—regardless of the level of concordance—can make a meaningful impact on the perinatal experience.

A Qualitative Study of Hospitals and Payers Implementing Community Doula Support

“…The value of racial concordance between doulas and their clients 37 must also consider the unique experience of Black doulas who experience stigma 16 and are witnesses to their clients’ inequitable care, a reality these data confirm 38 . Moreover, racial concordance does not necessarily address cultural concordance, 38 and cultural humility is critical in doula‐client relationships 39 …”

“…38 Moreover, racial concordance does not necessarily address cultural concordance, 38 and cultural humility is critical in doula-client relationships. 39 Similarly, an interventional culture was seen as a barrier to implementation among participants. Midwives have expertise in supporting physiologic birth and are natural champions for successful implementation.…”