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.

概括 黑人和拉丁女性的肥胖症患病率最高3。妇女肥胖症怀孕 在妊娠糖尿病，高血压疾病和急性心血管事件的风险过多 与正常体重女性相比，实验室和分娩4,5。因为孕妇有动力 健康的婴儿，怀孕提供了理想的“可教时间”，不仅减少了不良怀孕 结果，但最终防止女性及其婴儿的长期CMD 28,29。生活方式干预措施 解决怀孕的肥胖症有可能破坏肥胖和心脏代谢疾病的周期 （CMD）黑色和拉丁女性8。但是，多皮特的有效性证据，很少的生活方式干预措施 已在黑人或拉丁裔孕妇中进行了测试，或者在社区环境中实施， 许多高风险怀孕和产后妇女获得安全网服务。为了解决这个差距，我们 将利用我们团队的经验设计和测试基于证据的怀孕/产后健康 远程交付的教练干预（使用激励访谈 +基于Web的电话指导 平台 +手机行为跟踪）。与我们的马里兰州家庭访问伙伴一起，我们将适应 并将H42/H4U实施到家庭访问环境中，即H42/H4U-HV并量身定制Latinx的干预措施 和西班牙语女性。早期家庭参观是一种基于证据的公共卫生服务策略 所有50个国家针对高风险社区的服务以解决广告的社会确定健康。 家庭访客提供健康教育，促进积极的育儿和早期学习，并将家庭与 需要社区资源10。虽然家庭访问计划并未普遍优先考虑CMD风险 服务，它们是整合健康生活方式干预措施的理想服务策略。我们将使用一个 杂交1型有效性实施随机对照试验，以比较H42/H4U-的有效性 与通常的家庭访问服务相比，HV集成到家庭访问中，以减轻产后体重 在360孕妇中保留（产后6个月的孕前体重和体重之间的差异） 和产后妇女。我们还将评估干预措施的实施，以实现和维持 集成到家庭参观。健康差异会影响。量身定制和有针对性的远程保健 实施到早期家庭参观的教练干预有可能促进健康的生活方式行为 并消除肥胖症，不良怀孕结果和长期CMD的分布 黑人和拉丁裔怀孕和产后妇女及其婴儿。我们的研究方法使我们不得 仅建立H42/H4U-HV的有效性，但也了解使干预的因素 实施以告知可持续性，进一步从证据翻译成实践的途径，以及 促进更大的随后公共卫生影响11。