Effectiveness of an evidence-based health coaching program for reducing cardiometabolic risk among women and infants enrolled in early home visiting services

循证健康指导计划对于降低参与早期家访服务的妇女和婴儿心脏代谢风险的有效性

• 批准号: 10437339
• 负责人: Kelly Bower
• 金额: $ 69.59万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437339
• 关键词: Acute; Address; Adoption; Behavior; Behavioral; Breast Feeding; Car Phone; Cardiometabolic Disease; Cardiovascular system; Child Rearing; Chronic Disease; Communities; Diabetes Mellitus; Diet; Disease; Effectiveness; Enrollment; Event; Family; Future; Gestational Diabetes; Growth; Health; Health behavior; Health education; High Prevalence; High Risk Woman; Home; Home visitation; Hybrids; Hypertension; Infant; Infant Care; Intervention; Language; Latinx; Leadership; Learning; Link; Low income; Maryland; Maternal Health; Maternal Mortality; Mental Depression; Morbidity - disease rate; Newborn Infant; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Online Systems; Participant; Pathway interactions; Patients; Physical activity; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Complications; Pregnant Women; Public Health; Research; Risk; Role; Services; Sleep; Social support; Telephone; Testing; Training; Translations; United States; United States Public Health Service; Visit; Weight; Woman; adverse pregnancy outcome; base; black women; cardiometabolic risk; cardiometabolism; community partnership; comorbidity; compare effectiveness; design; disease disparity; disorder risk; disparity elimination; effectiveness implementation study; effectiveness implementation trial; effectiveness-implementation RCT; evidence base; experience; gestational weight gain; health care service utilization; health disparity; health equity; healthy lifestyle; high risk; implementation intervention; implementation science; infant outcome; innovation; intergenerational; lifestyle intervention; maternal outcome; mobile computing; motivational enhancement therapy; postpartum health; postpartum weight; prepregnancy; prepregnancy obesity; prevent; programs; remote delivery; safety net; smoking cessation; social health determinants; social stress

SUMMARY Black and Latinx women have the highest prevalence of obesity3. Women entering pregnancy with obesity have an excess risk of gestational diabetes, hypertensive disorders, and acute cardiovascular event during labor and delivery, compared to normal weight women4,5. Because pregnant women are motivated to have a healthy baby, pregnancy provides the ideal “teachable moment” to not only reduce adverse pregnancy outcomes, but ultimately prevent long-term CMD in women and their infants28,29. Lifestyle interventions addressing obesity in pregnancy have the potential to break the cycle of obesity and cardiometabolic disease (CMD) for Black and Latinx women8. However, despite evidence of effectiveness, few lifestyle interventions have been tested among Black or Latinx pregnant women or been implemented in community-based settings, where many high risk pregnant and postpartum women access safety-net services. To address this gap, we will leverage our team's experience designing and testing an evidence-based pregnancy/postpartum health coaching intervention that is remotely delivered (phone coaching using motivational interviewing + web-based platform + mobile phone behavioral tracking). Along with our Maryland home visiting partners, we will adapt and implement H42/H4U into the home visiting setting, i.e., H42/H4U-HV and tailor the intervention for Latinx and Spanish speaking women. Early home visiting is an evidence-based public health service strategy found in all 50 states that targets services to high-risk communities to address adverse social determinants of health. Home visitors provide health education, promote positive parenting and early learning, and link families with needed community resources10. While home visiting programs don't universally prioritize CMD risk in their services, they are an ideal service-strategy for integration of a healthy lifestyle intervention. We will use a hybrid type 1 effectiveness-implementation randomized control trial to compare the effectiveness of H42/H4U- HV integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention (difference between pre-pregnancy weight and weight at 6 months postpartum) among 360 pregnant and postpartum women. We will also evaluate the implementation of the intervention to enable and sustain integration into home visiting. Health Disparities Impact. A tailored and targeted remotely-delivered health coaching intervention implemented into early home visiting has potential to promote healthy lifestyle behaviors and eliminate disparities in obesity, adverse pregnancy outcomes, and long-term CMD among young high risk Black and Latinx pregnant and postpartum women and their infants. Our research approach allows us to not only establish the effectiveness of H42/H4U-HV but also understand the factors that enable intervention implementation to inform sustainability, further the pathway from evidence translation into practice, and facilitate greater subsequent public health impact11.

总结