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.

项目摘要 在美国，孕产妇发病率和死亡率过多是公共卫生危机 黑人妇女不成比例。数十年的研究未能改善这一危机。大多数研究 涉及黑人母亲的发病率和死亡率是根据以赤字为中心的框架结构的 这突出了所检查社区中个人的缺陷和不足。临床 此类研究导致的实践使孕产妇健康差异归一化并责备个人 那个黑人妇女经历。该提案涉及母亲的发病率和死亡率以及 通过利用黑色的保护资产，以赤字为重点的医疗保健模型 社区和个人，使用综合支持护理以及基于健康的移动技术 干预以降低产妇的发病率，死亡率和剖宫产，并改善与健康有关的 行为结果。我们的目标是提供以社区为中心的孕产妇健康的解决方案 基于黑人个人和黑人社区的固有优势的差异。基于我们 孕产妇适应能力的理论并基于我们以前的作品的发展，我们已经开发了一种小说 计划称为保护资产，以综合护理和技术（均等）加强。我们提出了一个 涉及384名黑人孕妇的随机试验和混合方法评估，在平等之间划分 计划参与者和信息控制（IC）。我们创新的，基于社区的干预将确定 干预参与者及其社区的优势和保护资产。在 社区环境，均等参与者与黑色杜拉斯（Black doulas）匹配，他们将提供基于优势的 整个怀孕连续性的指导，支持和社区资源。均等参与者会 还使用新颖的HIPAA符合HIPAA的移动技术平台来促进健康行为， 授权的优势和医疗保健依从性，同时还提供了与之联系的额外机会 基于社区的杜拉。该提案的具体目的是：（1）确定奇偶校验的影响 与IC相比，计划在严重的孕产妇发病率（主要结果），孕妇死亡率和剖宫产方面 黑人孕妇的出生（次要结果）； （2）确定平价计划对 与健康相关的行为结果，包括营养，体育锻炼，睡眠和医疗保健； （3） 评估孕产妇结局的变化是否是通过健康相关行为的变化介导的 结果以及奇偶校验对健康相关行为结果的影响是否由 授权优势的变化； （4）确定平等的障碍，促进者和感知的好处 干涉。拟议的研究提供了一种全面，创新的方法来解决母亲的发病率和 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，同时解决医疗保健访问，医疗保健质量以及每个参与者的社会需求。