PARITY: An integrated community care and strengths-based technology intervention to improve maternal wellness and reduce health disparities in Black women

项目摘要 在美国，产妇发病率和死亡率过高是一种公共卫生危机 不成比例的是黑人女性。几十年的研究都未能缓解这场危机。大多数研究 涉及黑人产妇发病率和死亡率是根据以赤字为重点的框架构建的， 它突出了被检查群体中个人的缺陷和不足。临床 这些研究产生的做法使产妇健康差距正常化并将其归咎于个人 黑人女性所经历的。这项建议涉及产妇发病率和死亡率以及 通过利用Black的保护性资产，关注孕产妇健康的赤字医疗保健模型 社区和个人，综合支持性护理的使用，以及基于健康的移动技术 采取干预措施降低孕产妇发病率、死亡率和剖宫产率，改善与健康相关的健康状况 行为结果。我们的目标是为孕产妇健康提供务实的、以社区为中心的解决方案 建立在黑人个人和黑人社区固有优势基础上的差异。基于我们的 母体适应能力理论和我们以前工作的基础上，我们开发了一种新的 该计划名为保护性资产，以综合护理和技术(平价)加强。我们提出了一个 对384名黑人孕妇进行的随机试验和混合方法评估，分为不同产次 计划参与者和信息控制(IC)。我们创新的、以社区为基础的干预将确定 干预参与者及其社区的优势和保护性资产。在 社区环境，平等参与者与将提供基于优势的黑色双人相匹配 在整个怀孕过程中提供指导、支持和社区资源。平价参与者将 还使用促进健康行为的新型HIPAA兼容移动技术平台， 增强优势，坚持医疗保健，同时提供更多机会与 以社区为基础的助产士。这项建议的具体目的是：(1)确定平价的影响 与IC相比，在严重孕产妇发病率(主要结果)、孕产妇死亡率和剖宫产方面 黑人孕妇的分娩(次要结果)；(2)确定生育计划对 与健康相关的行为结果，包括营养、体力活动、睡眠和保健依从性；(3) 评估产妇结局的变化是否受与健康相关的行为变化的影响 结果以及产次对健康相关行为结果的影响是否通过 赋权优势的变化；以及(4)确定平等的障碍、促进者和感知的好处 干预。拟议的研究提供了一种全面、创新的方法来解决孕产妇发病率和 通过整合基于优势的框架、新技术和基于同行的社区来降低死亡率 支持，同时解决每个参与者的医疗获取、医疗质量和社交需求。

Project Summary In the United States, excessive rates of maternal morbidity and mortality are a public health crisis borne disproportionately by Black women. Decades of research have failed to ameliorate this crisis. Most research involving Black maternal morbidity and mortality is structured according to a deficit-focused framework, which highlights the deficiencies and insufficiencies of individuals within the examined community. Clinical practices resulting from such research normalize and blame individuals for the maternal health disparities that Black women experience. This proposal addresses maternal morbidity and mortality and the impact of deficit-focused health care models on maternal health by leveraging the protective assets of Black communities and individuals, use of integrated supportive care, and a wellness-based mobile technology intervention to reduce maternal morbidity, mortality, and cesarean birth and improve wellness-related behavioral outcomes. Our goal is to offer pragmatic, community-centered solutions to maternal health disparities that build upon the inherent strengths of Black individuals and Black communities . Based on our theory of maternal adaptive capacity and building upon our previous work, we have developed a novel program called Protective Assets Reinforced with Integrated care and TechnologY (PARITY). We propose a randomized trial and mixed methods evaluation involving 384 Black pregnant women, divided between PARITY program participants and information control (IC). Our innovative, community-based intervention will identify the strengths and protective assets of intervention participants and of their communities. Within the community setting, PARITY participants are matched with Black doulas who will provide strengths-based guidance, support, and community resources throughout the pregnancy continuum. PARITY participants will also use a novel HIPAA compliant mobile technology platform that promotes wellness behaviors, empowered strengths, and healthcare adherence while offering additional opportunities to connect with the community-based doula. The specific aims of this proposal are: (1) Determine the effects of the PARITY program, as compared to IC, on severe maternal morbidity (primary outcome), maternal mortality, and cesarean birth (secondary outcomes) in Black pregnant women; (2) Determine the effects of the PARITY program on wellness-related behavioral outcomes including nutrition, physical activity, sleep, and healthcare adherence; (3) Assess whether changes in maternal outcomes are mediated by changes in wellness-related behavioral outcomes and whether the effects of PARITY on the wellness-related behavioral outcomes are mediated by changes in empowered strengths; and (4) Identify barriers, facilitators, and perceived benefits of the PARITY intervention. The proposed research offers a comprehensive, innovative approach to maternal morbidity and mortality reduction by integrating a strengths-based framework, novel technology, and peer-based community support, while addressing healthcare access, healthcare quality, and the social needs of each participant.