Healthy Beyond Pregnancy: Leveraging Behavior Economics to Improve Postpartum Care

项目总结 在重要的孕产妇和儿童健康结果方面，收入水平存在显著的不平等，包括 意外怀孕、母乳喂养持续时间和产后预防性或专科保健摄取。 这些差异的长期健康后果是有据可查的。一个重要的，但研究不足的 造成这些健康差距的原因是坚持产后护理。 高质量的产后护理针对当前和长期的妇幼保健需求，通过 提供避孕措施，支持母乳喂养，筛查妊娠心脏代谢并发症 以及为高危女性提供护理的联系。经济适用人群产后访视依从性研究 然而，处于不利地位的女性是贫穷的。产后护理比率的差异表明， 目前的护理模式并没有吸引所有女性的参与，而且不成比例地辜负了我们最脆弱的群体 母亲和婴儿。 我们研究议程的首要假设是，基于经验的干预 行为经济学的概念将改善产后访视的依从性，并促进 母婴健康。为此，我们设计了一种创新、可扩展且经济实惠的基于Web的 解决方案-怀孕后的健康。《怀孕后的健康》运用了行为经济学中公认的原则 瞄准行为改变的两个关键驱动因素--意识和意愿。我们的四大基石 计划是：(1)通过个性化的产后教育方法来应对信息过载和 护理，(2)通过正式的产后探视和承诺合同来克服自我控制问题，(3) 通过在产后立即督促妇女解决有限的注意力和提高意识 通过自动短信和(4)激励产后探视的完成。我们基于网络的平台 已构建，可用性测试已完成，并且我们成功地执行了一项试验性可行性试验，展示了我们的 能够以此申请所需的速度招募和注册科目。我们的下一个目标--重点 这项建议是进行一项务实的临床试验，以检验我们的假设，即接触HBP将 导致产后访视依从性增加30%，进而导致可测量的 改善对有效避孕措施的接受、母乳喂养持续时间和护理的联系 高危女性。我们已经组建了一支拥有所需知识和专业知识的多学科团队 为了这个项目。我们还让UPMC健康计划，一个重要的利益攸关方参与进来，因为他们是 在我们繁忙的妇产科医院，为经济困难的孕妇提供最大的保险公司，以支持这一点 科学的努力。我们的目标的成功完成将为传播试验提供基础 缩小短间隔妊娠、短母乳喂养持续时间和 并发症妊娠后随诊不足。

PROJECT SUMMARY There are striking inequalities by income level in important maternal child health outcomes, including rates of unintended pregnancies, breastfeeding duration and preventative or specialty health care uptake after delivery. The long-term health consequences of these disparities are well documented. An important, but under studied contributor to these health disparities is adherence to postpartum care. High quality postpartum care targets immediate and long-term maternal and child health needs through provision of contraception, support for breastfeeding, screening for cardio-metabolic complication of pregnancy and linkage to care for high-risk women. Adherence with the postpartum visit among economically disadvantaged women, however, is poor. The disparity in rates of postpartum care demonstrates that the current care model does not engage all women and disproportionately fails our most vulnerable mothers and babies. The overarching hypothesis of our research agenda is that an intervention grounded in empirically derived concepts of behavioral economics will improve compliance with the postpartum visit and promote equality in maternal child health. To this end, we have designed an innovative, scalable, and affordable web-based solution- Healthy Beyond Pregnancy. Healthy Beyond Pregnancy uses proven tenets of behavioral economics to target two critical drivers of behavioral change-- awareness and willingness. The four cornerstones of our program are: (1) combating information overload with a personalized approach to postpartum education and care, (2) overcoming self-control issues by formalizing the postpartum visit with a commitment contract, (3) addressing limited attention and increasing awareness by nudging women in the immediate postpartum period via automated text messaging and (4) incentivizing completion of the postpartum visit. Our web-based platform is built, usability testing is complete, and we successfully performed a pilot feasibility trial demonstrating our ability to recruit and enroll subjects at a rate needed for this application. Our next objective-- the focus of this proposal-- is to conduct a pragmatic clinical trial to test our hypothesis that exposure to HBP will result in a 30% increase in compliance with the postpartum visit and in turn lead to measureable improvements in uptake of effective contraception, breastfeeding duration, and linkage of care for high-risk women. We have assembled a multi-disciplinary team with the knowledge and expertise necessary for this project. We have also engaged the UPMC Health Plan, an important stakeholder, as they are the largest insurer of economically disadvantaged pregnant patients in our busy maternity hospital, to support this scientific endeavor. Successful completion of our aims will provide the foundation for a dissemination trial with the primary objective of narrowing the gap in short-interval pregnancies, short breastfeeding duration and inadequate follow-up after complicated pregnancy.