PARITY: An integrated community care and strengths-based technology intervention to improve maternal wellness and reduce health disparities in Black women

平等：综合社区护理和基于优势的技术干预，以改善孕产妇健康并减少黑人妇女的健康差距

• 批准号: 10701116
• 负责人: Elizabeth K Mollard
• 金额: $ 15.35万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701116
• 关键词: Address; Adherence; Affect; Behavior; Behavioral; Birth; Black Populations; Black race; Buffers; Caring; Centers for Disease Control and Prevention (U.S.); Cesarean section; Clinical; Clinical Trials; Communities; Community Health Aides; Complex; Cost Savings; Data Collection; Enrollment; Evaluation; Exercise; Goals; HELLP Syndrome; Health Care Costs; Health Insurance Portability and Accountability Act; Healthcare; Human; Hypertension; Individual; Informal Social Control; Intervention; Investments; Maternal Health; Maternal Mortality; Measures; Mediating; Medical; Methods; Modeling; Motivation; Nurse Midwives; Outcome; Participant; Physical activity; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnant Women; Problem Solving; Public Health; Reduce health disparities; Research; Research Methodology; Resources; Risk; Self Efficacy; Sleep; Social Conditions; Social support; Structure; Supportive care; Surveys; Technology; Testing; Time; United States; Woman; Work; barrier to care; base; behavioral outcome; black women; clinical practice; community center; community engagement; community setting; concept mapping; empowered; experience; health care availability; health care model; health care quality; health disparity; healthy pregnancy; improved; innovation; insight; intervention participants; lens; maternal morbidity; maternal outcome; member; mobile computing; mortality; new technology; novel; nutrition; peer; perinatal health; pilot test; pregnancy disorder; pregnancy hypertension; pregnant; prenatal; primary outcome; programs; protective effect; protective efficacy; racism; randomized trial; resilience; response; secondary outcome; severe maternal morbidity; social; theories

Project Summary In the United States, excessive rates of maternal morbidity and mortality are a public health crisis borne disproportionately by Black women. Decades of research have failed to ameliorate this crisis. Most research involving Black maternal morbidity and mortality is structured according to a deficit-focused framework, which highlights the deficiencies and insufficiencies of individuals within the examined community. Clinical practices resulting from such research normalize and blame individuals for the maternal health disparities that Black women experience. This proposal addresses maternal morbidity and mortality and the impact of deficit-focused health care models on maternal health by leveraging the protective assets of Black communities and individuals, use of integrated supportive care, and a wellness-based mobile technology intervention to reduce maternal morbidity, mortality, and cesarean birth and improve wellness-related behavioral outcomes. Our goal is to offer pragmatic, community-centered solutions to maternal health disparities that build upon the inherent strengths of Black individuals and Black communities . Based on our theory of maternal adaptive capacity and building upon our previous work, we have developed a novel program called Protective Assets Reinforced with Integrated care and TechnologY (PARITY). We propose a randomized trial and mixed methods evaluation involving 384 Black pregnant women, divided between PARITY program participants and information control (IC). Our innovative, community-based intervention will identify the strengths and protective assets of intervention participants and of their communities. Within the community setting, PARITY participants are matched with Black doulas who will provide strengths-based guidance, support, and community resources throughout the pregnancy continuum. PARITY participants will also use a novel HIPAA compliant mobile technology platform that promotes wellness behaviors, empowered strengths, and healthcare adherence while offering additional opportunities to connect with the community-based doula. The specific aims of this proposal are: (1) Determine the effects of the PARITY program, as compared to IC, on severe maternal morbidity (primary outcome), maternal mortality, and cesarean birth (secondary outcomes) in Black pregnant women; (2) Determine the effects of the PARITY program on wellness-related behavioral outcomes including nutrition, physical activity, sleep, and healthcare adherence; (3) Assess whether changes in maternal outcomes are mediated by changes in wellness-related behavioral outcomes and whether the effects of PARITY on the wellness-related behavioral outcomes are mediated by changes in empowered strengths; and (4) Identify barriers, facilitators, and perceived benefits of the PARITY intervention. The proposed research offers a comprehensive, innovative approach to maternal morbidity and mortality reduction by integrating a strengths-based framework, novel technology, and peer-based community support, while addressing healthcare access, healthcare quality, and the social needs of each participant.

项目摘要 在美国，过高的孕产妇发病率和死亡率是一场公共卫生危机， 黑人女性不成比例。几十年的研究都未能缓解这场危机。大多数研究 涉及黑人的孕产妇发病率和死亡率是根据以赤字为重点的框架制定的， 这突出了被调查群体中个人的缺陷和不合理性。临床 这种研究导致的做法使产妇健康差异正常化并将其归咎于个人 黑人女性的经历。该提案涉及孕产妇发病率和死亡率以及 通过利用黑人的保护性资产， 社区和个人，综合支持性护理的使用，以及基于健康的移动的技术 采取干预措施，减少产妇发病率、死亡率和剖腹产，并改善与健康有关的 行为结果我们的目标是为孕产妇健康提供务实的、以社区为中心的解决方案 建立在黑人个人和黑人社区固有优势基础上的差异。基于我们 理论的母亲适应能力和建设我们以前的工作，我们已经开发了一种新的 保护性资产加强与综合护理和技术（PARITY）。我们提出了一个 随机试验和混合方法评价，涉及384名黑人孕妇，分为PARITY 计划参与者和信息控制（IC）。我们创新的、以社区为基础的干预措施将确定 干预参与者及其社区的优势和保护资产。内 社区设置，PARITY参与者与黑人doulas匹配，后者将提供基于力量的 指导，支持和社区资源在整个怀孕过程中。参与者将 还使用了一个新的符合健康保险责任法案的移动的技术平台，促进健康行为， 增强的优势和医疗保健依从性，同时提供更多机会与 社区导乐该建议的具体目标是：（1）确定平价的影响 与IC相比，该计划对严重孕产妇发病率（主要结局）、孕产妇死亡率和剖宫产率的影响 黑人孕妇的分娩（次要结局）;（2）确定PARITY计划对 健康相关的行为结果，包括营养、体力活动、睡眠和医疗依从性;（3） 评估产妇结局的变化是否由健康相关行为的变化介导。 结果以及PARITY对健康相关行为结果的影响是否由以下因素介导： 授权优势的变化;（4）确定平等的障碍、促进因素和感知利益 干预拟议的研究为孕产妇发病率提供了一种全面的创新方法， 通过整合基于优势的框架、新技术和基于同伴的社区来降低死亡率 支持，同时解决医疗保健的可及性，医疗保健质量和每个参与者的社会需求。