Interview with Aliza Adler
Aliza Adler, MPH, is the Research, Data, and Evaluation Manager for Innovating Education in Reproductive Health, a program at the UCSF Bixby Center that produces evidence-based, digital, sexual, and reproductive health curricula. She serves as both the project manager and technical lead for the evaluation of the program’s curriculum, learning management software, and website data. Prior to joining Innovating Education, she worked as a Reproductive Health Specialist providing patient-centered care at Planned Parenthood Northern California. She recently received her MPH with a concentration in Maternal, Child, and Adolescent Health as well as a Graduate Data Science Certificate from UC Berkeley.
Hi Aliza! We are so excited about your upcoming publication for your capstone and would love to learn more about how the process was for you. Can you start by providing an overview of your capstone project and what your inspiration was behind choosing this particular topic for your capstone?
AA: My capstone examined the association between experiences of medical mistrust and mistreatment with ever considering self-managing an abortion (SMA) in a nationally representative sample. We found that experiences of medical mistrust and mistreatment are common and are associated with having considered SMA. We also found that individuals who identified with a structurally minoritized or marginalized group had higher proportions of SMA consideration. The project was conducted in conjunction with researchers at Advancing New Standards in Reproductive Health (ANSIRH), with data from the Self-Managed Abortion Attitudes Study (SMAASh). I had previously worked on a separate research project using the same data under the supervision of Dr. Lauren Ralph (also an MCAH alum!) and an opportunity arose to utilize the data for my capstone as well with Dr. Ralph serving as an external advisor. My research interests have always been in examining barriers to accessing reproductive health services – specifically abortion care – so this project really matched my interests.
How did the opportunity to publish a scientific journal article arise? Were there specific findings or aspects of your work that inspired your decision to publish?
AA: Prior to starting the project, I knew I wanted to publish my capstone research if possible. I knew I wanted to pursue a career in academic research or data analysis and knew that having more experience as a published author would help my career aspirations. Once the analysis was underway, we realized we had very significant results about a topic that had not yet been studied in-depth. This, coupled with the landscape of abortion restrictions in the United States and growing interest in SMA, really propelled me to attempt to publish the work.
Are there any specific aspects of the publication—whether it’s a particular methodology, analysis, or discussion point—that you found interesting or exciting?
AA: I think the entire manuscript is interesting and exciting – but I’m biased! Our main findings are really compelling and important as they point to large issues of mistrust and mistreatment in the healthcare system. We found that 5.2% of the population had ever considered SMA, 39% had moderate difficulty trusting healthcare providers, 17% experienced neglect of symptoms, and 22% experienced ridicule or humiliation in a previous healthcare encounter. We found that experiences of medical mistrust and mistreatment, along with identifying with a structurally minoritized or marginalized group, are associated with having considered SMA. These findings strongly suggest a need to create healthcare environments that foster trust and respect, as well as to ensure people have access to safe options for SMA.
We also employed a new way of examining differences in SMA consideration among demographic subgroups. To avoid centering whiteness by utilizing it as a reference group, we used binary contrasts to compare the likelihood of SMA consideration within a given subgroup to everyone not in that subgroup (versus an arbitrarily selected reference group). This is something of a novel approach to comparing demographic subgroups and it's exciting to incorporate a more equitable statistical approach in my manuscript.
Are there specific areas or questions that arose from your research, prompting ideas for future studies or investigations? How do you envision the impact of your work on the broader scientific community or related fields?
AA: I think my research highlights how our healthcare system is clearly failing a large percentage of the US population and many individuals consider seeking care outside of the formalized medical system. It’s quite telling that 39% of the population has experienced difficulty trusting healthcare providers and 22% has experienced ridicule or humiliation in a previous healthcare encounter. Based on the research, SMA consideration is quite prevalent (5.2%) and those who experience mistrust or mistreatment are more likely to consider SMA. We also found that structurally minoritized or marginalized participants were more likely to mistrust providers or experience mistreatment and consider SMA. In a context where abortion is restricted or criminalized, people who do not trust healthcare providers to protect their privacy may be more likely to attempt SMA and avoid care, including potentially necessary follow-up care. Though SMA is a valid and often effective and safe way to seek an abortion, it’s imperative to create healthcare systems where anyone can seek health services should they want or need to. Additionally, working to establish trust between providers and patients is crucial. My hope is that this research will highlight the need for drastic changes within the healthcare and medical education systems, with a specific focus on addressing discrimination and racism in healthcare encounters.
Did you collaborate with other researchers or mentors during the publication process? If yes, how did their guidance contribute to the final outcome?
AA: Yes! My manuscript would not be in the place it is today without all the guidance and support of my co-authors and collaborators. I collaborated very closely with researchers on the SMAASh research team at ANSIRH. Dr. Lauren Ralph served as my external chair/mentor on the project and her guidance throughout the project has been invaluable. My co-authors – Shelly Kaller, Dr. Antonia Biggs, Rosalyn Schroeder, Dr. Ndola Prata, and Dr. Karen Scott – provided feedback throughout my analysis and manuscript development. Dr. Karen Scott created many of the survey questions used in my analysis, including those used to construct the exposure variables of mistrust and mistreatment. In manuscript reviews, Dr. Scott also provided really valuable feedback regarding centering whiteness as a reference group, which prompted the use of the novel statistical approach I mentioned above.
Looking back, what advice would you give to other students embarking on their capstone projects with aspirations to publish their research in the future?
AA: The publication process can be really drawn out and tiring, so I really recommend that students are clear on why they want to publish their research. I think it’s easy to feel like you should want to publish or have pressures from external sources, but you will be the one doing the bulk of the work, so you should be sure this is something you are excited about doing. I would recommend writing this down somewhere to revisit during the process. It’s important to know that this process can take a long time, and that it’s okay to take breaks during it. It’s always okay to ask your co-authors for more support as well. Lastly, I would urge students to not fall into the “sunk cost” fallacy – it’s okay to walk away from your manuscript if it’s no longer serving you, even if you’ve put work into it. Remember to be kind to yourself!