Early Intervention to Promote Cardiovascular Health of Mothers and Children in Northern Appalachia

早期干预促进阿巴拉契亚北部母亲和儿童的心血管健康

• 批准号: 10618362
• 负责人: RICHARD S. LEGRO
• 金额: $ 75.77万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10618362
• 关键词: 2 year old; 3 year old; Address; Affect; American Heart Association; Appalachian Region; Area; Behavior; Behavior Therapy; Behavioral; Birth; Body mass index; Caring; Categories; Cessation of life; Child; Child Health; Child Rearing; Childbirth; Childhood; Client; Cluster randomized trial; Collaborations; Communities; Community Health; Computerized Medical Record; Conceptions; County; Documentation; Early Intervention; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Enrollment; Family; Family Nursing; Goals; Growth; Habits; Health; Health Care Sector; Health Personnel; Health Services Accessibility; Health system; Healthcare; Heart Diseases; Home; Home environment; Home visitation; Household; Implementation readiness; Infant; Infant Care; Informal Social Control; Interruption; Intervention; Intervention Studies; Knowledge; Lead; Life; Life Style; Link; Manuals; Maternal and Child Health; Measures; Metabolic syndrome; Minority Groups; Modeling; Mothers; Multi-Institutional Clinical Trial; Multicenter Trials; National Heart, Lung, and Blood Institute; Nurses; Nutritional; Nutritionist; Obesity; Outcome; Participant; Patient Recruitments; Phase; Positioning Attribute; Postpartum Period; Poverty; Pregnancy; Pregnant Women; Primary Care; Primary Prevention; Protocols documentation; Randomized; Research; Research Design; Risk; Risk Factors; Schedule; Self Efficacy; Site; Sleep; Testing; Tobacco use; Training; Treatment Efficacy; Visit; Vulnerable Populations; Weight; Woman; Work; cardiovascular health; caregiving; cigarette smoking; comorbidity; data sharing; design; disparity reduction; early childhood; economic disparity; effectiveness testing; efficacious intervention; experience; food security; health equity; health information technology; health of the mother; healthy lifestyle; high risk; hybrid type 1 trial; implementation context; improved; improved outcome; indexing; infancy; lifestyle intervention; maternal outcome; medically underserved; meetings; member; mortality; multidisciplinary; obesity prevention; obstetric care; operation; pilot test; prenatal; primary outcome; programs; psychosocial; rapid infant weight gain; role model; rural setting; skills; social cognitive theory; social health determinants; therapy design; tobacco exposure; tv watching; underserved area; urban setting

PROJECT SUMMARY/ABSTRACT As part of NHLBI’s ENRICH program, this research will test an implementation-ready intervention designed to improve cardiovascular health (CVH) among high risk mothers and young children during pregnancy and the first two years after delivery. Home visitation (HV) models meeting federal criteria of evidence of effectiveness will be leveraged to compare existing HV programs against those with an additional CVH intervention in a cluster-randomized, multicenter trial. Our multidisciplinary team has pioneered behavioral and lifestyle interventions for women during preconception and pregnancy and for infants during the first years after birth including those using HV for the primary prevention of obesity. We also have extensive research experience linking and integrating community- based healthcare programs with health system electronic medical records (EMRs). For this proposal, we will collaborate with two Nurse-Family Partnership agencies in Northern Appalachia, a medically underserved region with high rates of poverty and poor CVH, including high rates of obesity, heart disease, and tobacco use. We will enroll ≥500 of the 3000 pregnant women required for the UH3 phase multicenter trial. During the UG3 phase, we will pilot our proposed intervention with our community partners and work collaboratively with other ENRICH sites and NHLBI to develop the UH3 phase common protocol. Our proposed intervention incorporates tenets of Social Cognitive Theory and the Framework for Understanding Poverty using a skill-building curriculum that includes role modeling, goal-setting, and skill practice opportunities in the home. Five intervention pillars (Lifestyle Behaviors, Self-Regulation, Responsive Parenting, Home Environment, EMR Integration) are designed to increase maternal knowledge and self-efficacy in their ability to establish healthy lifestyle habits and maternal parenting practices to improve CVH. Consistent with a Hybrid Trial Type 1, the study design aims to understand the context for implementing the intervention. The composite primary outcome for mothers will be a modified version of the American Heart Association’s Life’s Simple 7 one year after childbirth; outcomes will also be assessed 2 years postpartum. The childhood primary outcome will be a composite of seven early life risk factors for poor CVH across with the final assessment at age 2 years. For these outcomes, the moderating effects of social determinants of health and psychosocial indices on outcomes will be explored. In addition, the context for implementation will be evaluated and factors influencing intervention efficacy will be identified to determine in HV, what works best, for whom, in which contexts, why and how. Lastly, we aim to lead network efforts to link and integrate HV summaries into EMRs to allow for data sharing with healthcare providers to enhance intervention effectiveness so that the UH3 protocol can evaluate whether EMR integration with HV programs improves CVH composite indicators as well as health equity.

项目总结/文摘