Effectiveness of an evidence-based health coaching program for reducing cardiometabolic risk among women and infants enrolled in early home visiting services

摘要 黑人和拉丁裔女性肥胖率最高。肥胖妇女进入孕期 患有妊娠期糖尿病、高血压疾病和急性心血管事件的风险过高 分娩和分娩，与正常体重的妇女相比，4，5。因为孕妇有动力有一个 健康的宝宝，孕期提供了理想的“教益时刻”，不仅可以减少不良妊娠 结果，但最终防止妇女及其婴儿的长期CMD 28，29。生活方式干预 解决怀孕期间的肥胖问题有可能打破肥胖和心脏代谢性疾病的循环 (CMD)适用于黑人和拉丁裔女性8。然而，尽管有证据表明有效，但很少有生活方式干预 已经在黑人或拉丁裔孕妇中进行了测试，或在社区环境中实施， 在那里，许多高危孕妇和产后妇女获得安全网服务。为了解决这一差距，我们 将利用我们团队设计和测试循证妊娠/产后健康的经验 远程提供的辅导干预(使用基于网络的激励性访谈进行电话辅导 平台移动电话行为跟踪)。与我们的马里兰州主场访问伙伴一起，我们将适应 并在家访设置中实现H42/H4U，即H42/H4U-HV，并为Latinx量身定制干预 和说西班牙语的女人。早期家访是一种基于证据的公共卫生服务战略，可在 所有50个州都以向高危社区提供服务为目标，以解决健康的不利社会决定因素。 家访人员提供健康教育，促进积极的育儿和早期学习，并将家庭与 需要的社区资源10。虽然家访计划并不普遍将CMD风险放在首位 服务，它们是整合健康生活方式干预的理想服务战略。我们将使用 混合类型1有效性-实施随机对照试验以比较H42/H4U的有效性 HV与常规家访服务在减轻产后体重方面的比较 360例孕妇产后6个月体重与孕前体重之差 和产后妇女。我们还将评估干预措施的实施情况，以使其能够和持续 融入家访。健康差距的影响。量身定做、针对性强的远程医疗服务 在早期家访中实施教练干预有可能促进健康的生活方式 消除肥胖、不良妊娠结局和长期CMD在年轻高危人群中的差异 黑人和拉丁裔孕妇和产后妇女及其婴儿。我们的研究方法使我们不能 不仅要确定H42/H4U-HV的有效性，还要了解使干预成为可能的因素 执行以告知可持续性，促进从证据转化为实践的途径，以及 促进更大的后续公共卫生影响11。

SUMMARY Black and Latinx women have the highest prevalence of obesity3. 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 women4,5. Because pregnant women are motivated to have a healthy baby, pregnancy provides the ideal “teachable moment” to not only reduce adverse pregnancy outcomes, but ultimately prevent long-term CMD in women and their infants28,29. Lifestyle interventions addressing obesity in pregnancy have the potential to break the cycle of obesity and cardiometabolic disease (CMD) for Black and Latinx women8. However, 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. To address this gap, we will leverage our team's experience designing and testing an evidence-based pregnancy/postpartum health coaching intervention that is remotely delivered (phone coaching using motivational interviewing + web-based platform + mobile phone behavioral tracking). Along with our Maryland home visiting partners, we will adapt and implement H42/H4U into the home visiting setting, i.e., H42/H4U-HV and tailor the intervention for Latinx and Spanish speaking women. Early home visiting 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 resources10. While home visiting programs don't universally prioritize CMD risk in their services, they are an ideal service-strategy for integration of a healthy lifestyle intervention. We will use a hybrid type 1 effectiveness-implementation randomized control trial to compare the effectiveness of H42/H4U- HV integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention (difference between pre-pregnancy weight and weight at 6 months postpartum) among 360 pregnant and postpartum women. We will also evaluate the implementation of the intervention to enable and sustain integration into home visiting. Health Disparities Impact. A tailored and targeted remotely-delivered health coaching intervention implemented into early home visiting 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. Our research approach allows us to not 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 impact11.