{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T18:02:43Z","timestamp":1776448963726,"version":"3.51.2"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"California Preterm Birth Initiative","award":["A133134"],"award-info":[{"award-number":["A133134"]}]},{"name":"California Health Care Foundation","award":["A139605"],"award-info":[{"award-number":["A139605"]}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["80229"],"award-info":[{"award-number":["80229"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"name":"California Preterm Birth Initiative","award":["A133134"],"award-info":[{"award-number":["A133134"]}]},{"name":"California Health Care Foundation","award":["A139605"],"award-info":[{"award-number":["A139605"]}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["80229"],"award-info":[{"award-number":["80229"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Comfort is a key factor in physical and mental health, influencing overall well-being. Though once seen as peripheral to the patient care experience, it is now recognized as a critical outcome. For Black and other historically minoritized birthing individuals\u2014who face racism, disproportionally higher morbidities, and unequal care\u2014comfort is key to a safe, positive pregnancy experience. Innovative, community-driven models designed to improve comfort are therefore needed. San Francisco\u2019s Pregnancy Village (PV) is a novel, cross-sector care delivery model providing a one-stop shop for clinical, city government, and wraparound services in a dignified and uplifting environment for Black and other minoritized pregnant individuals and their families. This study aims to examine comfort at PV and its key predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We surveyed 114 participants (57 pregnant\/postpartum individuals and 57 family members) between July 10, 2021 and June 30, 2022. Comfort was measured using a 3-item scale capturing the affective dimension of comfort, with scores standardized to 0\u2013100 scale. Additionally, two individual items assessed situational aspects of comfort: (1) discomfort being seen at PV and (2) feeling out of place at PV. We performed univariate, bivariate, and multivariate analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean comfort score was 96.2\/100 (\n                      <jats:italic>SD<\/jats:italic>\n                      \u2009=\u200911.4). Pregnant and postpartum participants, as well as those with limited social support, felt significantly less comfortable with the idea of being seen by friends at PV compared to family members and those with strong social support, respectively. Participants with some higher education and those reporting occasional everyday discrimination felt significantly less out of place at PV than those with a high school diploma or no discrimination experiences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Pregnancy Village model fostered generally high levels of comfort among Black and other minoritized pregnant individuals and their families in San Francisco, California. However, lower comfort levels among pregnant and postpartum individuals, those with lower educational attainment, and individuals lacking social support underscore the need for greater investment in co-led community-institutional, culturally responsive, and trauma-informed care approaches to foster comfort, particularly for those who face the severest inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0347316","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:27:31Z","timestamp":1776446851000},"page":"e0347316","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comfort in a cross-sector care delivery model to address birth inequities: Learnings from San Francisco\u2019s Pregnancy Village"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-0028","authenticated-orcid":true,"given":"Osamuedeme J.","family":"Odiase","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April J.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison M.","family":"El Ayadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KaSelah","family":"Crockett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malini A.","family":"Nijagal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6739-234X","authenticated-orcid":true,"given":"Patience A.","family":"Afulani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"pone.0347316.ref001","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s41043-023-00465-4","article-title":"A review on factors related to patient comfort experience in hospitals","volume":"42","author":"Y Tian","year":"2023","journal-title":"J Health Popul Nutr"},{"issue":"5","key":"pone.0347316.ref002","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033336","article-title":"Maximising comfort: how do patients describe the care that matters? A two-stage qualitative descriptive study to develop a quality improvement framework for comfort-related care in inpatient settings","volume":"10","author":"C Wensley","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0347316.ref003","volume-title":"Patient experience in adult NHS services: improving the experience of care for people using adult NHS services","year":"2012"},{"issue":"2","key":"pone.0347316.ref004","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1089\/jwh.2020.8868","article-title":"Health equity among Black women in the United States","volume":"30","author":"JJ Chinn","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"issue":"2","key":"pone.0347316.ref005","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1089\/jwh.2020.8874","article-title":"How implicit bias contributes to racial disparities in maternal morbidity and mortality in the United States","volume":"30","author":"B Saluja","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"issue":"1","key":"pone.0347316.ref006","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1089\/heq.2023.0266","article-title":"Examining Black birthing people\u2019s experiences with racism, discrimination, and contextualized stress and their perspectives on racial concordance with prenatal providers","volume":"8","author":"EN Teal","year":"2024","journal-title":"Health Equity"},{"issue":"3","key":"pone.0347316.ref007","doi-asserted-by":"crossref","first-page":"45","DOI":"10.9790\/1959-03314550","article-title":"Women\u2019s perception of husbands\u2019 support during pregnancy, labour and delivery","volume":"3","author":"RNS Mosunmola","year":"2014","journal-title":"IOSR J Nurs Health Sci"},{"issue":"1","key":"pone.0347316.ref008","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.apnu.2020.09.012","article-title":"Family involvement in pregnancy and psychological health among pregnant Black women","volume":"35","author":"M Hawkins","year":"2021","journal-title":"Arch Psychiatr Nurs"},{"key":"pone.0347316.ref009","article-title":"Anti-Black medical gaslighting in healthcare: experiences of Black women in Canada","author":"PN Boakye","year":"2024","journal-title":"Can J Nurs Res"},{"issue":"6","key":"pone.0347316.ref010","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.nwh.2022.09.008","article-title":"An integrative review of the perinatal experiences of Black women","volume":"26","author":"L Murphy","year":"2022","journal-title":"Nurs Womens Health"},{"key":"pone.0347316.ref011","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.socscimed.2018.02.013","article-title":"Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth","volume":"201","author":"MR McLemore","year":"2018","journal-title":"Soc Sci Med"},{"key":"pone.0347316.ref012","article-title":"Designing the built environment for a culture and system of patient safety \u2013 a conceptual, new design process.","volume-title":"Advances in Patient Safety: New Directions and Alternative Approaches","author":"KN Dickerman","year":"2008"},{"key":"pone.0347316.ref013","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.socscimed.2018.02.013","article-title":"Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth","volume":"201","author":"MR McLemore","year":"2018","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0347316.ref014","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12978-019-0729-2","article-title":"The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States","volume":"16","author":"S Vedam","year":"2019","journal-title":"Reprod Health"},{"issue":"4","key":"pone.0347316.ref015","first-page":"184","article-title":"Improving our maternity care now through community birth settings","volume":"31","author":"C Sakala","year":"2022","journal-title":"J Perinat Educ"},{"issue":"8","key":"pone.0347316.ref016","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2025.4411","article-title":"Community innovations to improve Black maternal health","volume":"6","author":"K Felix","year":"2025","journal-title":"JAMA Health Forum"},{"issue":"12","key":"pone.0347316.ref017","first-page":"768","article-title":"Building patient trust in hospitals: a combination of hospital-related factors and health care clinician behaviors","volume":"47","author":"J Greene","year":"2021","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"1","key":"pone.0347316.ref018","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1186\/s12913-021-06609-8","article-title":"Using human centered design to identify opportunities for reducing inequities in perinatal care","volume":"21","author":"MA Nijagal","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0347316.ref019","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/birt.12839","article-title":"The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco","volume":"52","author":"MA Nijagal","year":"2025","journal-title":"Birth"},{"key":"pone.0347316.ref020","volume-title":"SFDPH Tableau data","author":"SPDPH MCAH","year":"2021"},{"key":"pone.0347316.ref021","volume-title":"California Department of Public Health Vital Records Business Intelligence System (VRBIS)","author":"California Department of Public Health Maternal, Child, and Adolescent Health","year":"2022"},{"issue":"1","key":"pone.0347316.ref022","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s44294-025-00108-5","article-title":"Accessibility and acceptability of San Francisco\u2019s Pregnancy Village model: a mixed-methods evaluation","volume":"3","author":"OJ Odiase","year":"2025","journal-title":"Npj Womens Health"},{"key":"pone.0347316.ref023","author":"PC Diala","year":"2025"},{"key":"pone.0347316.ref024","author":"Comfort Line [Internet]"},{"issue":"10","key":"pone.0347316.ref025","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3390\/children6100107","article-title":"The hunger vital sign identifies household food insecurity among children in emergency departments and primary care","volume":"6","author":"RK Gattu","year":"2019","journal-title":"Children"},{"key":"pone.0347316.ref026"},{"issue":"4","key":"pone.0347316.ref027","first-page":"502","article-title":"Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients","volume":"21","author":"ME Peek","year":"2011","journal-title":"Ethn Dis"},{"key":"pone.0347316.ref028","article-title":"Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls","volume":"338","author":"JAC Sterne","year":"2009","journal-title":"BMJ"},{"key":"pone.0347316.ref029","volume-title":"Stata Statistical Software: Release 14","author":"StataCorp","year":"2017"},{"key":"pone.0347316.ref030","volume-title":"Centering pregnancy in New Jersey: Results of a mixed methods evaluation"},{"issue":"1","key":"pone.0347316.ref031","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/1049732310378655","article-title":"Women\u2019s experience of group prenatal care","volume":"21","author":"G Novick","year":"2011","journal-title":"Qual Health Res"},{"key":"pone.0347316.ref032","author":"K Cox","year":"2024"},{"issue":"8","key":"pone.0347316.ref033","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1001\/archinte.166.8.896","article-title":"Racial differences in trust in health care providers","volume":"166","author":"CH Halbert","year":"2006","journal-title":"Arch Intern Med"},{"issue":"4","key":"pone.0347316.ref034","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1177\/089124100129023963","article-title":"But I am a good mom: the social construction of motherhood through health-care conversations","volume":"29","author":"RW Tardy","year":"2000","journal-title":"J Contemp Ethnogr"},{"issue":"5","key":"pone.0347316.ref035","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/00006842-200009000-00016","article-title":"Maternal social support predicts birth weight and fetal growth in human pregnancy","volume":"62","author":"PJ Feldman","year":"2000","journal-title":"Psychosom Med"},{"issue":"6","key":"pone.0347316.ref036","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/NMC.0000000000000183","article-title":"Father involvement and psychological well-being of pregnant women","volume":"40","author":"C Giurgescu","year":"2015","journal-title":"MCN Am J Matern Child Nurs"},{"key":"pone.0347316.ref037","volume-title":"Health Behavior: Theory, Research, and Practice","author":"K Glanz","year":"2015","edition":"5"},{"issue":"1","key":"pone.0347316.ref038","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1186\/s12913-022-08527-9","article-title":"Impact of low health literacy on patients\u2019 health outcomes: a multicenter cohort study","volume":"22","author":"R Shahid","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0347316.ref039","doi-asserted-by":"crossref","first-page":"248","DOI":"10.2105\/AJPH.93.2.248","article-title":"Paved with good intentions: do public health and human service providers contribute to racial\/ethnic disparities in health?","volume":"93","author":"M van Ryn","year":"2003","journal-title":"Am J Public Health"},{"key":"pone.0347316.ref040","doi-asserted-by":"crossref","DOI":"10.17226\/10883","author":"L Nielsen-Bohlman","year":"2004","journal-title":"Health Literacy: A Prescription to End Confusion. Washington, D.C.: National Academies Press"},{"issue":"2","key":"pone.0347316.ref041","doi-asserted-by":"crossref","first-page":"866","DOI":"10.4081\/jphr.2017.866","article-title":"Cancer screening information at community health fairs: What the participants do with information they receive","volume":"6","author":"E Monrose","year":"2017","journal-title":"J Public Health Res"},{"key":"pone.0347316.ref042","doi-asserted-by":"crossref","first-page":"116509","DOI":"10.1016\/j.socscimed.2023.116509","article-title":"Belonging, endurance, and resistance: black placemaking theory in primary care","volume":"342","author":"OH Ordaz","year":"2024","journal-title":"Soc Sci Med"},{"key":"pone.0347316.ref043","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/0263276416635259","article-title":"Black placemaking: celebration, play, and poetry","volume":"33","author":"MA Hunter","year":"2016","journal-title":"Theory Cult Soc"},{"issue":"7","key":"pone.0347316.ref044","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1177\/1049732318759528","article-title":"Group medical visits as participatory care in community health centers","volume":"28","author":"A Thompson-Lastad","year":"2018","journal-title":"Qual Health Res"},{"issue":"1","key":"pone.0347316.ref045","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1177\/0042085920971354","article-title":"Studying Black student life on campus: toward a theory of Black placemaking in higher education","volume":"59","author":"AA Tichavakunda","year":"2020","journal-title":"Urban Educ"},{"key":"pone.0347316.ref046","author":"EJ Marksbury","year":"2023"},{"issue":"6","key":"pone.0347316.ref047","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1080\/13557858.2024.2359384","article-title":"Reclaiming narratives of empowerment around Black maternal health: a strengths-based, community-informed focus group study","volume":"29","author":"E Mollard","year":"2024","journal-title":"Ethn Health"},{"issue":"4","key":"pone.0347316.ref048","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3390\/genealogy4040119","article-title":"Healing through ancestral knowledge and letters to our children: mothering infants during a global pandemic","volume":"4","author":"MG Valdovinos","year":"2020","journal-title":"Genealogy"},{"issue":"1","key":"pone.0347316.ref049","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1891\/1058-1243.20.1.45","article-title":"African American women\u2019s preparation for childbirth from the perspective of African American Health-Care Providers","volume":"20","author":"C Abbyad","year":"2011","journal-title":"J Perinat Educ"},{"issue":"2","key":"pone.0347316.ref050","doi-asserted-by":"crossref","first-page":"227","DOI":"10.18865\/ed.31.2.227","article-title":"Traversing traditions: prenatal care and birthing practice preferences among Black women in North Florida","volume":"31","author":"ME Deichen Hansen","year":"2021","journal-title":"Ethn Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347316","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:27:39Z","timestamp":1776446859000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347316"}},"subtitle":[],"editor":[{"given":"Kwang-Sig","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347316","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]}}}