The Mid-Atlantic Center for Cardiometabolic Health Equity (MACCHE) Diversity Supplement

点击翻译按钮获取中文摘要

Summary of the Funded Parent Grant. This proposal is a supplement to a sub-project of “The Mid-Atlantic Center for Cardiometabolic Health Equity (MACCHE)” (NIMHD 5P50MD017348-02; MPI: Cooper and Crews) entitled “Effectiveness of an evidence-based health coaching program for reducing cardiometabolic risk among women and infants enrolled in early home visiting services” (MPI: Bower/Bennett). Black and Latinx women have the highest prevalence of obesity.1 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 women. 2,3 Lifestyle interventions addressing obesity in pregnancy have the potential to break the cycle of obesity and cardiometabolic disease (CMD) for Black and Latinx women and their offspring.4 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. Early home visiting (HV) 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 resources.5 This is a hybrid type 1 effectiveness-implementation randomized control trial comparing the effectiveness of H42/H4U- HV, a remotely delivered evidence-based pregnancy/postpartum health coaching intervention, integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention among 360 pregnant and postpartum women. We will evaluate the implementation of the intervention to enable and sustain integration into home visiting. H42/H4U-HV, which is tailored for Black, Latinx, Spanish speaking women and implemented into early home visiting programs 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. We aim to 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 impact.6