The following application is for practicing doulas 18 and older who are interested in participating in the Medicaid Doula Program Implementation Study project through AcademyHealth and the University of Pittsburgh. Participation entails three, 90-minute-long focus group interviews over the course of five years. All research participants will be compensated for their time.

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* 1. First name:

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* 2. Last name:

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* 3. Email:

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* 4. Phone number:

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* 5. What is the best way to contact you? Note: If you do not have a preference, please select both boxes.

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* 6. Are you 18 years of age or older?

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* 7. Are you currently a practicing doula?

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* 8. If yes, please list which state(s) you practice in. If no, please enter N/A.

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* 9. Do you have a Hispanic or
Latino ethnic background?

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* 10. What is your race? Please feel free to select all that apply.

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* 11. Have you ever worked with birthing persons enrolled in Medicaid?

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* 12. If yes, do you currently work with birthing persons enrolled in Medicaid?

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* 13. If no, do you plan to work with birthing persons enrolled in Medicaid in the future?

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* 14. Do you work with Black birthing people and/or other birthing people of color?

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* 15. Are you available to participate in 3 focus group interviews over the course of 5 years? Each interview will be 90 minutes long, interview slots will be offered at various times, and you will be compensated for your time.

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* 16. What general time frame(s) might you be available for a focus group interview?

  Morning (8am-12pm ET) Afternoon (12pm-5pm ET) Evening (5pm-9pm ET)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 17. If you are a human, please select A and B. If not, please select C.

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