Patient navigation to improve outcomes among low-income women in the postpartum period

患者导航可改善低收入女性产后的结局

基本信息

批准号：
10331608
负责人：
Lynn M Yee
金额：
$ 23.41万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10331608
关键词：
2019-nCoV Academic advising Address Adherence American College of Obstetricians and Gynecologists Attitude Automobile Driving Belief COVID-19 disparity COVID-19 mortality COVID-19 pandemic COVID-19 vaccination COVID-19 vaccine Centers for Disease Control and Prevention (U.S.)Communicable Diseases Counseling Data Diphtheria Evaluation Failure Fetal health Funding Future Goals HIV HIV Seronegativity Health Health Campaign Healthcare Hospitals Immunocompromised Host Individual Influenza Intervention Interview Investigation Knowledge Low income Maternal Health Maternal-fetal medicine Minority Morbidity - disease rate Motivation National Institute of Child Health and Human Development Neonatal Patients Perception Pertussis Population Population Heterogeneity Postpartum Period Postpartum Women Pregnancy Pregnant Women Preventive Preventive care Provider Public Health Recommendation Research Risk Safety Sampling Services Societies Strategic Planning Structure Tetanus Time Trust Underrepresented Populations United States United States National Institutes of Health Vaccination Vaccine Research Vaccines Vulnerable Populations Woman Women&apos s Health Work World Health Organization antenatal ethnic minority population experience global health health care availability health disparity implementation strategy improved outcome influenza virus vaccine mortality motherhood novel novel vaccines obstetric care patient oriented preference pregnant programs racial minority recruit shared decision making social culture social health determinants social structure standard of care uptake vaccine acceptance vaccine access vaccine hesitancy vaccine safety

项目摘要

PROJECT SUMMARY Pregnancy is a critical window of opportunity for preventive health interventions, including vaccines. Yet, vaccine hesitancy is a known global phenomenon. Uptake of the currently recommended vaccines in pregnancy (influenza and tetanus, diphtheria, and pertussis [TDaP]) is suboptimal, with only 50% of individuals receiving recommended vaccines. Disparities in vaccine uptake exist, yet this issue has not been thoroughly investigated from the patient perspective. Little is known about the perspectives of pregnant women who identify as racial or ethnic minorities or pregnant women living with HIV (WLHIV), both of whom are underrepresented and understudied populations who are at greater risk of complications from conditions such as influenza. Additionally, the COVID-19 pandemic and introduction of a novel vaccine to health care presents an urgent need to understand factors driving vaccination uptake, particularly in vulnerable populations such as racial and ethnic minority pregnant and postpartum women and WLHIV. Early data suggest that pregnant women and immunocompromised people – such as those living with HIV - are at increased risk of morbidity and mortality from COVID-19. Understanding the evolving perspectives of these populations will inform educational and counseling strategies to enhance vaccination uptake in pregnancy and reduce vaccination disparities. Aim 1 will assess the experiences and preferences of racial and ethnic minority pregnant and postpartum WLHIV and HIV-seronegative women with regard to standard of care vaccines during pregnancy. Individual interviews will address perceptions, experiences, and decisions surrounding routine vaccinations during pregnancy, including issues of trust, access, and knowledge. Analyses will additionally compare perspectives on routine vaccines that may differ by HIV status. Aim 2 will examine the perspectives of this population on the novel COVID-19 vaccine. We will explore motivations and sociocultural underpinnings that may clarify the concerns, beliefs, and experiences surrounding COVID-19 vaccination in pregnancy. We will additionally compare the perspectives of women with and without HIV, and we will analyze differences in attitudes for the COVID-19 vaccine versus standard of care vaccines. To accomplish these aims, we will recruit 40 pregnant or recently postpartum women in partnership with the NICHD-funded Navigating New Motherhood 2 study and the Northwestern Memorial Hospital Women’s Infectious Diseases Program. Women with and without HIV will be demographically similar in order to focus on a diverse population of understudied women who are largely low- income and from a racial or ethnic minority. This proposal aims to fill an unmet need for a systematic, in-depth, and unbiased evaluation of the attitudes and preferences of understudied populations of women regarding routine and novel vaccinations during pregnancy. This project directly aligns with the Trans-NIH Strategic Plan for Women’s Health Research goals and the aims will address intersections of social determinants of health in diverse populations of women.

项目概要怀孕是预防性健康干预措施（包括疫苗）的关键机会之窗。怀孕期间对目前推荐的疫苗接种犹豫不决是一个众所周知的全球现象。（流感和破伤风、白喉和百日咳 [TDaP]）效果不佳，只有 50% 的人接受了治疗推荐的疫苗接种情况存在差异，但这一问题尚未得到彻底调查。从患者的角度来看，人们对种族或种族歧视的孕妇的观点知之甚少。少数族裔或感染艾滋病毒的孕妇 (WLHIV)，这两类人的代表性均不足，并且未被充分研究的人群，他们因流感等疾病而出现并发症的风险更大。此外，COVID-19 大流行和在医疗保健中引入新型疫苗提出了迫切需要了解推动疫苗接种的因素，特别是在种族和民族等弱势群体中早期数据表明，少数孕妇和产后妇女与WLHIV有关。免疫功能低下的人，例如艾滋病毒感染者，发病和死亡的风险增加了解这些人群不断变化的观点将为教育和提高妊娠期疫苗接种率并减少疫苗接种差异的咨询策略。目标 1 将评估怀孕和产后 WLHIV 的少数种族和族裔的经历和偏好和艾滋病毒血清阴性妇女有关怀孕期间护理疫苗标准的个人访谈。将讨论有关怀孕期间常规疫苗接种的看法、经验和决定，包括信任、访问和知识问题的分析还将比较对日常事务的看法。目标 2 将研究该人群对小说的看法。 COVID-19 疫苗。我们将探讨可能澄清这些担忧的动机和社会文化基础，我们还将比较怀孕期间有关 COVID-19 疫苗接种的信念和经验。感染和未感染 HIV 的女性的观点，我们将分析对 COVID-19 态度的差异疫苗与标准护理疫苗的比较为了实现这些目标，我们将招募 40 名怀孕或刚刚怀孕的人。产后妇女与 NICHD 资助的 Navigating New Motherhood 2 研究和西北纪念医院妇女传染病项目将针对感染和未感染艾滋病毒的妇女进行。人口统计相似，以便重点关注未受研究的不同女性群体，这些女性大多是低收入群体来自少数种族或族裔的收入。该提案旨在满足对态度和态度进行系统、深入和公正评估的未满足的需求。未受研究的妇女群体对怀孕期间常规和新型疫苗接种的偏好。该项目与跨 NIH 女性健康研究战略计划的目标和目标直接一致将解决不同妇女群体健康问题社会决定因素的交叉问题。