ENRICH ALABAMA: Improving cardiovascular health of women and children through a novel home visiting intervention

ENRICH ALABAMA：通过新颖的家访干预措施改善妇女和儿童的心血管健康

基本信息

批准号：
10426961
负责人：
Gareth R Dutton
金额：
$ 57.92万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-05 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10426961
关键词：
Adherence Adolescence Affect African American Age Alabama Behavior Therapy Blood Pressure Body mass index Cardiovascular Diseases Caring Child Childhood Chronic Clinical Collaborations Community Practice Country County Data Collection Deterioration Dose Early Intervention Education Effectiveness of Interventions Enrollment Family Gestational Age Gestational Diabetes Glucose Health Health Benefit Health behavior Home Home environment Home visitation Household Hypertension Income Infrastructure Interdisciplinary Study Intervention Life Lipids Low income Maternal and Child Health Measures Medical Morbidity - disease rate Mothers Obesity Outcome Perinatal Phase Physical activity Pilot Projects Positioning Attribute Postpartum Period Pre-Eclampsia Pregnancy Preparation Procedures Protocols documentation Public Policy Race Reach Effectiveness Adoption Implementation and Maintenance Recommendation Research Research Design Research Personnel Resources Risk Risk Factors Services Site Sleep Smoking Standardization Time Training Vulnerable Populations Woman Women&apos s Health Work adverse pregnancy outcome aged base behavioral health intervention black women burden of illness cardiovascular health cardiovascular risk factor clinical center clinical practice community engagement contextual factors demographics design dietary early childhood effectiveness evaluation effectiveness implementation study effectiveness implementation trial effectiveness outcome ethnic minority evidence base experience follow-up gestational weight gain good diet health care availability health of the mother health related quality of life high risk implementation evaluation implementation outcomes improved improved outcome in utero maternal risk member mortality next generation novel obesity prevention offspring preservation preventive intervention primary outcome programs psychosocial racial and ethnic racial minority secondary outcome sedentary social health determinants sustainability framework tobacco exposure

项目摘要

PROJECT SUMMARY / ABSTRACT Rates of poor cardiovascular health (CVH) and cardiovascular disease (CVD) mortality for women are greatest among racial/ethnic minorities, those with low-income, and residents of the southeastern U.S. Women’s cardiovascular risk factors relate to risk for adverse pregnancy outcomes and affect the CVH of their children. Effective and scalable interventions that improve or preserve CVH of vulnerable mothers and children are urgently needed, and home visiting programs provide a unique and efficient platform to intervene during these critical life periods. As part of the “Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH)” program, this application proposes an ENRICH clinical center in Alabama (AL), a state with some of the nation’s poorest CVH and highest CVD mortality. This project builds upon and expands our ongoing work to evaluate an obesity prevention intervention integrated into home visiting services in AL. In collaboration with our home visiting program partners and the national ENRICH consortium, we propose to design and implement ENRICH-AL, a novel behavioral intervention promoting maternal and child CVH among families enrolled in five large home visiting programs that provide services in 39 AL counties. We will conduct a type 1 hybrid effectiveness-implementation trial (N=500-600 dyads, including high-risk mothers and their child aged 0- 4 years). During an average follow-up of 3 years, the trial will compare CVH indicators in mothers and children receiving ENRICH-AL versus standard home visiting services. In preparation for this trial, a 2-year UG3 planning phase includes 2 aims – UG3 Aim 1: Develop intervention content/delivery and a common protocol; and UG3 Aim 2: Conduct pilot studies to refine the intervention and common protocol, and train home visiting and research staff in the final protocol. Following successful attainment of UG3 milestones, the 5-year UH3 implementation phase will include the following aims – UH3 Aim 1: Evaluate effectiveness of the intervention based on a composite measure of CVH in women and standardized BMI-for-age (z-score) in children (primary outcomes); UH3 Aim 2: Evaluate effectiveness of the intervention for other CVH risk factors, psychosocial outcomes, and contextual factors (secondary outcomes); UH3 Aim 3: Evaluate ENRICH-AL implementation outcomes guided by the RE-AIM framework; and UH3 exploratory aim: Examine treatment moderators, including demographics, social determinants of health, and pregnancy-related factors. Given 1) our existing research collaborations with home visiting programs, 2) expertise in conducting CVH interventions, 3) participation in other large, multi-site collaborative projects, and 4) the disproportionate CVD burden experienced in AL, we are uniquely-positioned to contribute to this important initiative to identify effective and scalable solutions to improve CVH among women and children.

项目摘要 /摘要女性心血管健康（CVH）和心血管疾病（CVD）死亡率较差的发生率最高在种族/族裔少数民族中，有低收入的人和美国东南部妇女的居民心血管危险因素与不良妊娠结局的风险有关，并影响孩子的CVH。有效且可扩展的干预措施可以改善或保存脆弱的母亲和儿童的CVH 迫切需要，家庭访问计划提供了一个独特而有效的平台，可以在这些过程中进行干预关键的生活时期。作为“促进母亲和儿童心血管健康的早期干预的一部分（丰富）”计划，该申请提出了一个在阿拉巴马州（AL）的丰富临床中心，该州有一些美国最贫穷的CVH和CVD死亡率最高。这个项目建立并扩展了我们正在进行的工作以评估整合到AL中的家庭访问服务中的目标预防干预措施。合作与我们的家庭访问计划合作伙伴和国家丰富财团一起，我们建议设计和实施丰富的行为干预促进遗产和儿童CVH的新型行为干预措施参加了五个大型家庭访问计划，这些计划在39个县提供服务。我们将进行1型混合有效性实施试验（n = 500-600二元，包括高风险母亲及其儿童0- 4年）。在3年的平均随访期间，该试验将比较母亲和儿童的CVH指标接收丰富与标准家庭访问服务。为了准备这项试验，一项2年的UG3 计划阶段包括2个目标 - UG3 AIM 1：开发干预内容/交付和共同协议；和UG3 AIM 2：进行试点研究以完善干预和共同协议，并训练回家访问和最终协议中的研究人员。成功达到UG3里程碑后，UH3 5年实施阶段将包括以下目标 - UH3 AIM 1：评估干预的有效性基于对妇女的CVH的综合测量，儿童的标准化BMI-For-For-For-for-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-For-Age（Z分数）结果）； UH3 AIM 2：评估干预措施对其他CVH风险因素，心理社会的有效性结果和上下文因素（次要结果）； UH3 AIM 3：评估丰富实施由Re-Aim框架指导的结果；和UH3探索目的：检查治疗主持人，包括人口统计学，健康的社会决定者和与怀孕有关的因素。给定1）我们现有与家庭访问计划的研究合作，2）进行CVH干预方面的专业知识，3）参与其他大型多站点协作项目，以及4）不成比例的CVD Burnen 在AL中，我们有独特的位置，为这一重要倡议做出贡献，以确定有效和可扩展的解决方案以改善妇女和儿童的CVH。