714 - NICU Health Equity Rounds: A Mixed-Methods Evaluation of a Collaborative, Community-Engaged, and Lived-Experience-Informed Curriculum

Publication Number: 1691.714

Mariana Nino de Guzman Ramirez, University of Colorado School of Medicine, Denver, CO, United States; Aniekanabasi Udoko, Children's Hospital Colorado/Univsersity of Colorado, Aurora, CO, United States; Allison J. Matti, University of Colorado, Arvada, CO, United States; Christina R. Fisher, University of Colorado School of Medicine, Aurora, CO, United States; Paula Dias Maia, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Jennifer C. Miller, Childrens Hospital Colorado, Denver, CO, United States; Jeanne Zenge, University of Colorado School of Medicine, Aurora, CO, United States; Sunah S. Hwang, University of Colorado School of Medicine, Denver, CO, United States

Background: Health inequities among high-risk infants and their caregivers persist in the US. Implicit and explicit bias contribute to adverse health experiences among minoritized families. Health Equity Rounds (HER) provide an avenue to promote equitable neonatal care that is culturally responsive and strength-based by addressing individual and systemic barriers and facilitators. In Spring 2024, a multi-disciplinary group at Children's Hospital Colorado, co-created and implemented NICU HER, a case-based, community-engaged curriculum for NICU staff that integrates individuals with lived experience as well as Diversity, Equity and Inclusion experts through all stages of development and delivery.

Objective: To investigate the effectiveness of HER on participants' self-reported ability to: 1) Recognize the impact of implicit bias and social determinants of health on neonatal care; 2) Examine individual and system-level biases within health care; 3) Promote equity within their professional and personal spheres.

Design/Methods: With IRB approval from the University of Colorado, using a mixed methods approach, data was collected and analyzed between Spring 2024-2025. After each HER session, participants completed quantitative evaluation surveys about their knowledge of how health equity-related factors influence health, and the effectiveness of HER in changing individual or systems-level practice. Semi-structured interviews were conducted to explore participants' perspectives and perceived impact of the sessions. Interviews continued until thematic saturation was reached. Transcripts were de-identified and analyzed using rapid qualitative methods, with coding conducted by HER members with qualitative methodology expertise. Discrepancies were resolved by consensus.

Results: Following HER, participants reported an increase in their knowledge of health equity topics, comfort in engaging in equity discussions, ability to identify factors that lead to inequities and ability to identify practice changes (Figure 1). Participant interviews revealed increased self-awareness of biases and enhanced learning from lived experience expert presentations (Table 2).

Conclusion(s): In this evaluation of NICU HER, we demonstrate significant improvement in participant knowledge about health equity-related issues in the NICU and level of empowerment for practice change. Overall, HER was well-received and considered to be effective in educating participants about identifying and addressing inequitable care, providing opportunities to examine individual and system-level biases, and empowering participants to create change within their communities.

Table 1: Summary of Health Equity Rounds Series Cases


Figure 1: Confidence in Addressing Health Equity Topics Prior to and After Participation in Health Equity Rounds
Participants were asked to rate their confidence on a scale 1-5 (where 1 is low confidence and 5 is highly confident) prior to and after participation in health equity rounds for the following topics: addressing bias; defining health equity (HE), social determinants of health (SDoH) and dimensions of difference (DoD); identifying practice changes; and identifying systemic inequities. Aggregate mean confidence scores for all participants reported.

Table 2: Comments from Health Equity Rounds Participants.
Themes and notable quotes from semi-structured interviews conducted after participation in Health Equity Rounds.