ENRICH ALABAMA: Improving cardiovascular health of women and children through a novel home visiting intervention

ENRICH ALABAMA：通过新颖的家访干预措施改善妇女和儿童的心血管健康

• 批准号: 10426961
• 负责人: Gareth R Dutton
• 金额: $ 57.92万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426961
• 关键词: Adherence; Adolescence; Affect; African American; Age; Alabama; Behavior Therapy; Blood Pressure; Body mass index; Cardiovascular Diseases; Caring; Child; Childhood; Chronic; Clinical; Collaborations; Community Practice; Country; County; Data Collection; Deterioration; Dose; Early Intervention; Education; Effectiveness of Interventions; Enrollment; Family; Gestational Age; Gestational Diabetes; Glucose; Health; Health Benefit; Health behavior; Home; Home environment; Home visitation; Household; Hypertension; Income; Infrastructure; Interdisciplinary Study; Intervention; Life; Lipids; Low income; Maternal and Child Health; Measures; Medical; Morbidity - disease rate; Mothers; Obesity; Outcome; Perinatal; Phase; Physical activity; Pilot Projects; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Pregnancy; Preparation; Procedures; Protocols documentation; Public Policy; Race; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Research; Research Design; Research Personnel; Resources; Risk; Risk Factors; Services; Site; Sleep; Smoking; Standardization; Time; Training; Vulnerable Populations; Woman; Women' s Health; Work; adverse pregnancy outcome; aged; base; behavioral health intervention; black women; burden of illness; cardiovascular health; cardiovascular risk factor; clinical center; clinical practice; community engagement; contextual factors; demographics; design; dietary; early childhood; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness outcome; ethnic minority; evidence base; experience; follow-up; gestational weight gain; good diet; health care availability; health of the mother; health related quality of life; high risk; implementation evaluation; implementation outcomes; improved; improved outcome; in utero; maternal risk; member; mortality; next generation; novel; obesity prevention; offspring; preservation; preventive intervention; primary outcome; programs; psychosocial; racial and ethnic; racial minority; secondary outcome; sedentary; social health determinants; sustainability framework; tobacco exposure

PROJECT SUMMARY / ABSTRACT Rates of poor cardiovascular health (CVH) and cardiovascular disease (CVD) mortality for women are greatest among racial/ethnic minorities, those with low-income, and residents of the southeastern U.S. Women’s cardiovascular risk factors relate to risk for adverse pregnancy outcomes and affect the CVH of their children. Effective and scalable interventions that improve or preserve CVH of vulnerable mothers and children are urgently needed, and home visiting programs provide a unique and efficient platform to intervene during these critical life periods. As part of the “Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH)” program, this application proposes an ENRICH clinical center in Alabama (AL), a state with some of the nation’s poorest CVH and highest CVD mortality. This project builds upon and expands our ongoing work to evaluate an obesity prevention intervention integrated into home visiting services in AL. In collaboration with our home visiting program partners and the national ENRICH consortium, we propose to design and implement ENRICH-AL, a novel behavioral intervention promoting maternal and child CVH among families enrolled in five large home visiting programs that provide services in 39 AL counties. We will conduct a type 1 hybrid effectiveness-implementation trial (N=500-600 dyads, including high-risk mothers and their child aged 0- 4 years). During an average follow-up of 3 years, the trial will compare CVH indicators in mothers and children receiving ENRICH-AL versus standard home visiting services. In preparation for this trial, a 2-year UG3 planning phase includes 2 aims – UG3 Aim 1: Develop intervention content/delivery and a common protocol; and UG3 Aim 2: Conduct pilot studies to refine the intervention and common protocol, and train home visiting and research staff in the final protocol. Following successful attainment of UG3 milestones, the 5-year UH3 implementation phase will include the following aims – UH3 Aim 1: Evaluate effectiveness of the intervention based on a composite measure of CVH in women and standardized BMI-for-age (z-score) in children (primary outcomes); UH3 Aim 2: Evaluate effectiveness of the intervention for other CVH risk factors, psychosocial outcomes, and contextual factors (secondary outcomes); UH3 Aim 3: Evaluate ENRICH-AL implementation outcomes guided by the RE-AIM framework; and UH3 exploratory aim: Examine treatment moderators, including demographics, social determinants of health, and pregnancy-related factors. Given 1) our existing research collaborations with home visiting programs, 2) expertise in conducting CVH interventions, 3) participation in other large, multi-site collaborative projects, and 4) the disproportionate CVD burden experienced in AL, we are uniquely-positioned to contribute to this important initiative to identify effective and scalable solutions to improve CVH among women and children.

项目摘要/摘要