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The Effect of a Culturally Sensitive Educational Intervention on Acceptance of Neuraxial Anesthesia in Hispanic and Caucasian Parturients: A Randomized Controlled Trial
Abstract Number: T-04
Abstract Type: Original Research
Large disparities in access to medical care exist between Hispanic and non-Hispanic Americans. Hispanic women receive epidural labor analgesia much less frequently than their non-Hispanic counterparts despite studies repeatedly demonstrating that it offers the best pain control. We tested the hypothesis that an epidural-focused, language-appropriate educational intervention could dispel epidural-related myths and improve epidural usage rates.
In this single-blinded, randomized controlled trial Hispanic and non-Hispanic women were randomized upon arrival to labor and delivery to a pamphlet and video (intervention) targeting common myths about epidurals in the subject’s home language (English or Spanish) or standard of care (control). Eligible women were ≥ 18 years, ASA I-III, gestation ≥ 24 weeks, on Medicaid, assigned to a M.D., and free to choose epidural analgesia. All women completed a short Beliefs About Epidurals Questionnaire (BAEQ) before (pre-test) and after (post-test) their randomized intervention. The BAEQ assessed subject agreement with commonly cited non-evidence-based reasons for avoiding epidural analgesia with points awarded for incorrect answers. The effect of the intervention on epidural usage rates (data presented as % that choose epidural in intervention vs. control) was compared with the Fisher’s exact test and BAEQ scores (presented as median, IQR for pre-test vs. post-test) were compared with the Wilcoxon signed-rank test. Two-sided p-values < 0.05 were statistically significant.
This is an interim analysis of 58 non-Hispanic (29 intervention and 29 control) and 26 Hispanic (9 intervention and 17 control) parturients out of a planned 176 subjects (44 per group). There was a non-significant trend towards a higher epidural usage rate in Hispanic women that received the intervention (100% vs. 76%, p = 0.26). Non-Hispanics receiving additional education did not elect epidural analgesia more often (93% vs. 97%, p = 0.62). Both Hispanic [(5, IQR 2,7) vs. (2, IQR 2,2), W = 2.5 < critical 3, N too small to calculate p-value) and non-Hispanic [(3, IQR 2,4) vs. (2, IQR 0,3), W = 26, p = 0.003] women that received the intervention achieved more correct answers on the BAEQ. Non-Hispanic women randomized to standard of care did not have improved BAEQ scores [(3, IQR 1.5,4) vs. (1, IQR 1,3), W = 42, p = 0.10]; however, Hispanic control subjects did [(5, IQR 4,6) vs. (3, IQR 2,3), W = 7.5, p = 0.005].
In this interim analysis, the educational intervention improved epidural analgesia knowledge and seemed to help dispel epidural-related myths for both Hispanic or non-Hispanic parturients; however, improved knowledge did not translate into a higher epidural usage rate. This suggests that the decision to choose epidural analgesia is multifactorial and improved peripartum knowledge about epidurals may not, by itself, be enough to effect epidural usage patterns.