Presentation
Using Patient Journey Mapping to Compare Black Maternal Healthcare Experiences in Canada and the United States
SessionPoster Session 2
DescriptionIntroduction
In 2024, Ontario, Canada, accounted for over 144 000 of the 360 000 live births nationally [1], [2], making it a significant focus for understanding maternal health outcomes and experiences. While challenges already exist for birthing people (BP), they are exacerbated for racialized groups. This is specifically the case with severe maternal morbidity (SMM), defined as any condition during pregnancy that threatens maternal mortality [3]. Canadian maternal health patients experiencing SMM are most likely to come from low-income backgrounds or African or Carribean countries [3], [4]. While maternal mortality and morbidity are important indicators of the quality of healthcare available to BP, there is growing recognition that maternal care must be evaluated not solely through clinical outcomes, but rather through the lived experiences of patients.
Patient Journey Mapping (PJM) is a visualization tool increasingly used in healthcare to illustrate the patient's experience at each point in their care journey [2]. While PJM has been applied to examine both prenatal [5] and postpartum [6] care experience , PJM can be a valuable tool for highlighting encounters where racialized women report disrespect, dismissal, and gaps in support.
Currently, knowledge of differences in care experiences between Canada and the United States(US) remains limited, even though such comparisons are common in health research and maternal health disparities have been reported in both countries. Thus, this study uses PJM to contrast the maternal care experiences of Black BP in both Canada and the US. By examining the similarities and differences, we can generate insights into factors that shape inequities in care and contribute to adverse outcomes, and identify opportunities for improvement in each context.
Methods
This study is part of a larger study following the maternal care journey of patients in both the US and Canada. This study followed a mixed-methods study design. Participants were at least 18 years old, at least 20 weeks pregnant, and identified as a Black woman or BP. Participants from the US were recruited from a local hospital and the participants from Canada were recruited within the Ontario community. We recruited a prenatal and postpartum cohort. Prenatal participants are recruited between 20 and 26 weeks pregnant, while postpartum participants are recruited within the first two weeks of their delivery.
Data collection
Participants completed surveys at multiple points during their prenatal and postpartum journeys. Each participant received a survey link hosted on REDCap via their preferred contact method (SMS or email). Prenatal participants were surveyed at 28, 32, and 36 weeks of pregnancy, while postpartum participants were surveyed at 2, 4, and 6 weeks after delivery. To better reflect the US patient experience, additional surveys were administered at 24 weeks of pregnancy and 12 weeks postpartum. Survey topics included screenings, education, family planning, complications, and other aspects of the birthing experience. Surveys were followed by open-ended interviews at both the prenatal and postpartum phases of the study. Interviews were conducted in person, by phone, or via Zoom. They explored birth preparation, experiences of safety and risk, pain management strategies, interactions with healthcare providers, and other challenges.
Data Analysis and PJM Creation
Descriptive statistics such as mean and percentages were used to summarize the survey data on number of visits, length of visits, and topics discussed during each visit. Sentiment analysis was conducted using Python on qualitative data from the surveys and interviews to extract specific experience patterns across key touchpoints in care. Aggregated journey maps were developed in Miro, an online collaborative whiteboard, for prenatal and postpartum care across Canada and the US, integrating survey responses and qualitative themes.
Results
The study included 7 participants (3 prenatal, 4 postpartum) from Canada and 7 (3 prenatal, 4 postpartum) participants from the US. While prenatal appointment details such as appointment lengths, topics, and screenings completed vary between patients in both countries, on average, prenatal patients in Canada and the US described very positive experiences and reported that thier appointment expectations met. While the Canadian participants reported an overall positive experience with their care, the US participants reported a less positive experiences, for the care received during the intrapartum and postpartum phases. One key difference noted was that in Canada, the healthcare providers (HCP) HCP who cared for participants during pregnancy were also present during labour most of the time. This was not the case for US patients despite participants expressing this preference.
Sentiment analysis found that HCPs were generally viewed as open and helpful, however, dismissive attitudes towards patient concerns and stereotyping were reported. Participants in Canada reported inconsistent referral to resources practices, where some participants reporting the need to advocate for themselves to be connected to resources while others were overwhelmed with an excess of information they could not navigate.
Presence of community resources in care, including friends, family, and support groups varies among participants in both countries. Both surveys and sentiment analysis showed that Canadian participants placed value on prenatal and childbirth classes, received community support outside of formal care, and benefited from additional birth and postpartum support from friends and family. In contrast, US participants reported that their prenatal education were typically provided only by HCPs, childbirth classes were less frequently attended, and support from friends and family was limited
Discussion
Examining the journeys of Black women and BPs in Canadian and US allows for key similarities and differences between the two maternal healthcare systems to emerge While patients entered care with expectations shaped by their lived experiences, the ability to largely meet varying expectations despite varying appointment details (including content and length suggests) that Canadian and US HCP’s can effectively care for a variety of patients. Conversely, the recurring accounts of dismissive communication and stereotyping by HCPs mirror findings from prior studies that describe poor experiences during healthcare encounters by Black women and birthing people [7], [8], [9]. These parallels point to a persistent bias across both systems and emphasize the need to strengthen communication, empathy, and patient-centeredness as essential components of equitable and safe care.
Limitations. It is worth noting that, because of the small sample size of study participants, each aggregate map is only based on three or four patient experiences. As a result, while there is enough contributing data to the aggregate maps to identify similarities and differences between the maps themselves, future iterations of the study will require increasing the number of study participants to ensure the aggregate maps more accurately reflect an average Black patient experience. Future studies should also incorporate participants of other races to facilitate comparisons and more accurately represent racial disparities in care.
Conclusion
Analyzing the differences between the Canadian and US systems presents more opportunities to strengthen the maternal care experience in one or both countries. The differences identified show that, when compared to its Canadian counterpart, the US system lacks an emphasis on community-based resources such as friends, family, and support groups in their care, and consistency between prenatal and postpartum HCP’s. As a result, opportunities to specifically strengthen the US system include ensuring that HCP’s are confident in referring patients to external classes and support groups, and that they are equipped to assist their prenatal patients during birth and postpartum phases. On the other hand, when compared to its US counterpart, the Canadian system is more prone to over-referrals or under-referrals and employs more general care strategies. Thus, the Canadian system in specific can be strengthened by emphasizing a stronger balance between HCP-led and referred care and ensuring HCP’s can tailor said care to more effectively address unique needs of patients.
In 2024, Ontario, Canada, accounted for over 144 000 of the 360 000 live births nationally [1], [2], making it a significant focus for understanding maternal health outcomes and experiences. While challenges already exist for birthing people (BP), they are exacerbated for racialized groups. This is specifically the case with severe maternal morbidity (SMM), defined as any condition during pregnancy that threatens maternal mortality [3]. Canadian maternal health patients experiencing SMM are most likely to come from low-income backgrounds or African or Carribean countries [3], [4]. While maternal mortality and morbidity are important indicators of the quality of healthcare available to BP, there is growing recognition that maternal care must be evaluated not solely through clinical outcomes, but rather through the lived experiences of patients.
Patient Journey Mapping (PJM) is a visualization tool increasingly used in healthcare to illustrate the patient's experience at each point in their care journey [2]. While PJM has been applied to examine both prenatal [5] and postpartum [6] care experience , PJM can be a valuable tool for highlighting encounters where racialized women report disrespect, dismissal, and gaps in support.
Currently, knowledge of differences in care experiences between Canada and the United States(US) remains limited, even though such comparisons are common in health research and maternal health disparities have been reported in both countries. Thus, this study uses PJM to contrast the maternal care experiences of Black BP in both Canada and the US. By examining the similarities and differences, we can generate insights into factors that shape inequities in care and contribute to adverse outcomes, and identify opportunities for improvement in each context.
Methods
This study is part of a larger study following the maternal care journey of patients in both the US and Canada. This study followed a mixed-methods study design. Participants were at least 18 years old, at least 20 weeks pregnant, and identified as a Black woman or BP. Participants from the US were recruited from a local hospital and the participants from Canada were recruited within the Ontario community. We recruited a prenatal and postpartum cohort. Prenatal participants are recruited between 20 and 26 weeks pregnant, while postpartum participants are recruited within the first two weeks of their delivery.
Data collection
Participants completed surveys at multiple points during their prenatal and postpartum journeys. Each participant received a survey link hosted on REDCap via their preferred contact method (SMS or email). Prenatal participants were surveyed at 28, 32, and 36 weeks of pregnancy, while postpartum participants were surveyed at 2, 4, and 6 weeks after delivery. To better reflect the US patient experience, additional surveys were administered at 24 weeks of pregnancy and 12 weeks postpartum. Survey topics included screenings, education, family planning, complications, and other aspects of the birthing experience. Surveys were followed by open-ended interviews at both the prenatal and postpartum phases of the study. Interviews were conducted in person, by phone, or via Zoom. They explored birth preparation, experiences of safety and risk, pain management strategies, interactions with healthcare providers, and other challenges.
Data Analysis and PJM Creation
Descriptive statistics such as mean and percentages were used to summarize the survey data on number of visits, length of visits, and topics discussed during each visit. Sentiment analysis was conducted using Python on qualitative data from the surveys and interviews to extract specific experience patterns across key touchpoints in care. Aggregated journey maps were developed in Miro, an online collaborative whiteboard, for prenatal and postpartum care across Canada and the US, integrating survey responses and qualitative themes.
Results
The study included 7 participants (3 prenatal, 4 postpartum) from Canada and 7 (3 prenatal, 4 postpartum) participants from the US. While prenatal appointment details such as appointment lengths, topics, and screenings completed vary between patients in both countries, on average, prenatal patients in Canada and the US described very positive experiences and reported that thier appointment expectations met. While the Canadian participants reported an overall positive experience with their care, the US participants reported a less positive experiences, for the care received during the intrapartum and postpartum phases. One key difference noted was that in Canada, the healthcare providers (HCP) HCP who cared for participants during pregnancy were also present during labour most of the time. This was not the case for US patients despite participants expressing this preference.
Sentiment analysis found that HCPs were generally viewed as open and helpful, however, dismissive attitudes towards patient concerns and stereotyping were reported. Participants in Canada reported inconsistent referral to resources practices, where some participants reporting the need to advocate for themselves to be connected to resources while others were overwhelmed with an excess of information they could not navigate.
Presence of community resources in care, including friends, family, and support groups varies among participants in both countries. Both surveys and sentiment analysis showed that Canadian participants placed value on prenatal and childbirth classes, received community support outside of formal care, and benefited from additional birth and postpartum support from friends and family. In contrast, US participants reported that their prenatal education were typically provided only by HCPs, childbirth classes were less frequently attended, and support from friends and family was limited
Discussion
Examining the journeys of Black women and BPs in Canadian and US allows for key similarities and differences between the two maternal healthcare systems to emerge While patients entered care with expectations shaped by their lived experiences, the ability to largely meet varying expectations despite varying appointment details (including content and length suggests) that Canadian and US HCP’s can effectively care for a variety of patients. Conversely, the recurring accounts of dismissive communication and stereotyping by HCPs mirror findings from prior studies that describe poor experiences during healthcare encounters by Black women and birthing people [7], [8], [9]. These parallels point to a persistent bias across both systems and emphasize the need to strengthen communication, empathy, and patient-centeredness as essential components of equitable and safe care.
Limitations. It is worth noting that, because of the small sample size of study participants, each aggregate map is only based on three or four patient experiences. As a result, while there is enough contributing data to the aggregate maps to identify similarities and differences between the maps themselves, future iterations of the study will require increasing the number of study participants to ensure the aggregate maps more accurately reflect an average Black patient experience. Future studies should also incorporate participants of other races to facilitate comparisons and more accurately represent racial disparities in care.
Conclusion
Analyzing the differences between the Canadian and US systems presents more opportunities to strengthen the maternal care experience in one or both countries. The differences identified show that, when compared to its Canadian counterpart, the US system lacks an emphasis on community-based resources such as friends, family, and support groups in their care, and consistency between prenatal and postpartum HCP’s. As a result, opportunities to specifically strengthen the US system include ensuring that HCP’s are confident in referring patients to external classes and support groups, and that they are equipped to assist their prenatal patients during birth and postpartum phases. On the other hand, when compared to its US counterpart, the Canadian system is more prone to over-referrals or under-referrals and employs more general care strategies. Thus, the Canadian system in specific can be strengthened by emphasizing a stronger balance between HCP-led and referred care and ensuring HCP’s can tailor said care to more effectively address unique needs of patients.
Event Type
Poster Presentation
TimeTuesday, March 244:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments