A Randomized Control Trial of a Culturally Relevant Maternal Wellness App to Improve Black Maternal Mental Health Outcomes

一项与文化相关的孕产妇健康应用程序的随机对照试验，以改善黑人孕产妇心理健康结果

• 批准号: 10593841
• 负责人: Eynav Elgavish Accortt
• 金额: $ 20.88万
• 依托单位: CEDARS-SINAI 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: 2022-09-27 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10593841
• 关键词: Address; Adherence; Advocacy; Advocate; Anxiety; Anxiety Disorders; Automobile Driving; Behavioral; Biological; Biological Testing; Birth; Black race; Blood; C-reactive protein; COVID-19; CREB1 gene; Caring; Child; Childbirth; Clinical; Clinical effectiveness; Communication; Communication Barriers; Communities; Community Networks; Complication; Control Groups; Coupled; Data; Diagnosis; Diagnostic; Discrimination; Education; Etiology; Functional disorder; Gene Expression Profile; Genes; Gestational Diabetes; Goals; Health; Healthcare; Healthy People 2020; Inflammation; Inflammatory; Intervention; Knowledge; Laws; Light; Los Angeles; Low Birth Weight Infant; Maternal Health; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Minority; Mobile Health Application; Mood Disorders; Mothers; Multi-Institutional Clinical Trial; Outcome; Participant; Patients; Perinatal; Physicians; Physiological; Population; Positioning Attribute; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnant Women; Prevalence; Primary Health Care; Provider; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Proposals; Risk; Risk Factors; Role; Small for Gestational Age Infant; Source; Spottings; Stress; Structure; Symptoms; Techniques; Telemedicine; Testing; Visit; Well in self; Woman; Work; adverse outcome; base; black patient; black women; clinical care; comparison intervention; cultural competence; design; differential expression; effective intervention; experience; follow-up; group intervention; health disparity; health equity; improved; improved outcome; insight; jun Oncogene; mHealth; minority patient; novel; online care; perinatal mental health; perinatal outcomes; perinatal period; physical conditioning; physical symptom; premature; prenatal; prevent; prospective; psychoeducation; public health relevance; racial disparity; racism; screening; self help; skills; standard of care; stress management; support network; systemic inflammatory response; transcription factor; virtual; women of color

Project Summary/Abstract Perinatal Mood and Anxiety Disorders (PMADs) encompass a range of mental health disorders that occur during pregnancy and up to one year postpartum. Approximately 13% of women experience PMADs. This rate doubles for those with adverse perinatal outcomes (APO) and triples in Black women. Recent research points to racism as one significant source of these health disparities. Cultural adaptations to improve communication with providers decrease rates of depression in minority patients as well as improve adherence to treatment, insight and alliance. Discrimination stress and worries about experiencing medical consequences are thought to increase systemic inflammation, a mechanism known to drive mental and physical symptoms. Inflammation has been implicated in both PMADs and APO, suggesting a shared underlying etiology. Evidence from our work suggests that inflammation contributes to the pathophysiology of PMADs. The proposed pilot randomized control trial will allow us to build on promising preliminary results and identify whether our culturally relevant mobile Health (mHealth) intervention is effective in improving outcomes among Black pregnant women randomized to the intervention compared to a control group. The culturally relevant modules include building communication and self-advocacy skills and provide a support network. The primary objective of this research is to provide guidance for clinical care of Black women during the perinatal period, with the goal to improve mental health and physical health outcomes. A secondary goal is to examine novel inflammatory signatures that change as a function of the intervention to reduce PMADs in this population. As inflammation may be diagnostic of PMADs, identification of its role may shed light of potential intervention targets and provide critical knowledge to improve women’s long-term health. PMAD symptoms will be assessed prospectively in 150 Black pregnant women, half of whom will be randomized to receive the culturally relevant mHealth intervention. We hypothesize that women in the intervention group will have reduced rates of PMADs and APOs, an increase in adherence to mental health treatment and will report increased self-advocacy skills, increased communication with providers, and reduced levels of discrimination related stress. They will also have improved biological risk indicators including lower circulating C-reactive protein and a transcription profile of differentially expressed inflammatory genes, marked by a decreased activity of inflammatory transcription factors from blood spots. Given the high burden of both PMADs and APOs among Black mothers and the numerous consequences on maternal and child outcomes, it is imperative that we develop and implement effective interventions, and test the biological mechanisms that might drive these effects. This work is interdisciplinary, building on a network of community advocates to implement a novel mHealth intervention informed by real world experiences designed to enhance self-advocacy, reduce stress and prevent adverse outcomes.

项目总结/文摘