Joyuus: A Web-based Tool for Postpartum Care Self-care to Address the Complex Needs of Underserved Women

项目概要/摘要 在美国，产后期是母婴健康的关键时期;美国孕产妇 死亡率是其他发达高收入国家中最高的。超过一半的产妇 死亡发生在产后，从出生后一天到一年。 产妇死亡率和严重发病率，黑人和拉丁裔母亲以及其他 BIPOC女性黑人妇女的孕产妇死亡率是白色妇女的3-4倍10， 西班牙裔女性经历严重孕产妇结局的可能性是非西班牙裔女性的两倍 白色妇女。11美国妇产科医师学会认识到， 产后护理，并创造了术语“第四个三个月”，以标记出生后的时间，通过前3- 产后数月。他们最近更新了应对这些挑战的建议。 《Back Better Act》也将这一问题列为优先事项。Joyuus是一个基于网络的自我保健移动的工具， 在产后30个月内，为服务不足的妇女减少可避免的发病率和死亡率风险。工具 解决影响产后护理质量的生理、心理、真实的世界、文化和知识障碍。 Joyuus提供信息，资源，专家观点，同行交流和红旗， 以各种形式帮助妇女确定如何养成健康的自我保健习惯。重要的是，它还确定了 当自我保健导致寻求提供者的照顾。孕妇经常求助于互联网查找信息 关于他们的健康和他们正在发育的宝宝的健康。然而，研究发现，母亲们没有找到足够的 13我们的第一阶段赠款在黑人妇女的样本中得到了证明。 这一受众在收入和教育程度方面都高度参与，并且更喜欢移动的接入 和基于文本的通信。在第二阶段，我们将继续努力，包括妇女的生活经验， 在我们建立完整的工具时，最有可能产生负面产后结果的风险。我们的第一步将是进行 需求评估，以了解拉丁美洲的信息，文化和语言需求和需求 人口更广泛的随机试验将邀请不同人群的BIPOC和白色妇女。我们 第二阶段范围旨在完成三项主要任务： 目标1：扩大可行性活动，以解决拉丁裔人口。探索自我护理（和寻求护理） 产后拉丁社区的需求，并与我们的第一阶段重点小组的调查结果相结合。 目标2：构建完整的工具。我们将完成基于移动的完全交互式Joyuus网络的开发 英语和西班牙语的工具。 目的3：随机对照试验的检验。我们将测试Joyuus的有效性与一个不同的国家 产后妇女的样本，考虑到对产妇功能，抑郁，焦虑，恢复力， 知识和社会支持。

PROJECT SUMMARY/ABSTRACT In the United States, the postpartum period is a critical time for both maternal and child health; the US maternal mortality rate is the highest among other developed, high-income countries. More than half of all maternal deaths occur postpartum, from one day to one year after birth.1-9 There are vast racial and ethnic disparities in maternal mortality and severe morbidity, disproportionately experienced by Black and Latina mothers and other BIPOC women. Black women are 3-4 times more likely to experience maternal mortality than white women10, and Hispanic women are twice as likely to experience severe maternal outcomes compared with non-Hispanic white women.11 The American College of Obstetricians and Gynecologists recognized the deficiencies in postpartum care and coined the term the ‘fourth trimester’ to mark the time following birth through the first 3- months postpartum. They recently updated recommendations to address these challenges.12 The Biden Build Back Better Act also prioritized this issue. Joyuus is a web-based self-care mobile tool addressing the 12 months postpartum, to reduce the risks of avoidable morbidity and mortality for underserved women. The tool addresses physical, mental, real world, cultural, and knowledge barriers which impact quality postpartum care. Joyuus provides information, resources, expert perspectives, peer communications and red flags presented in a variety of formats to help women identify how to adopt healthy self-care habits. Importantly, it also identifies when self-care leads to seeking provider care. Pregnant women often turn to the internet to find information about their health and their developing baby's health. Yet, studies find that mothers are not finding sufficient resources to match their postpartum needs.13 Our Phase I grant demonstrated in a sample of Black women that this audience is highly engaged across the income and education spectrum and prefers mobile access and text-based communication. In Phase II we will continue our efforts to include lived experiences of women most at risk for negative postpartum outcomes as we build the complete tool. Our first step will be to conduct a needs assessment to understand informational, cultural and language wants and needs in the Latina population. The broader randomized trial will invite a diverse population of BIPOC and white women. Our Phase II scope aims to complete three major tasks: AIM 1: Expand feasibility activities to address Latina population. Explore self-care (and seeking care) needs for the postpartum Latina community and integrate with our Phase I focus group findings. AIM 2: Build complete tool. We will complete the development of a fully interactive Joyuus web based mobile tool in English and Spanish. AIM 3: Test in randomized controlled trial. We will test the effectiveness of Joyuus with a diverse national sample of postpartum women, considering the impact on maternal function, depression, anxiety, resilience, knowledge, and social support.