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

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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.