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: 10709664
• 负责人: Elizabeth K Mollard
• 金额: $ 15.11万
• 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/10709664
• 关键词: Address; Adherence; Affect; Behavior; Behavioral; Birth; Black Populations; Black race; Buffers; Caring; Cesarean section; Clinical; Clinical Trials; Communities; Community Health Aides; Community Healthcare; Complex; Cost Savings; Data Collection; Evaluation; Exercise; Goals; HELLP Syndrome; Health Care Costs; Health Insurance Portability and Accountability Act; Healthcare; Healthcare promotion; 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; United States; Woman; Work; barrier to care; behavioral outcome; black women; clinical practice; community center; community engagement; community setting; comparison control; concept mapping; empowerment; experience; health care availability; health care model; health care quality; health disparity; healthy pregnancy; improved; innovation; insight; integrated care; intervention participants; lens; maternal morbidity; maternal outcome; member; mobile computing; mortality; new technology; novel; nutrition; participant enrollment; 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; technology platform; 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.

项目总结