Colorado Nurse Family Heart Trial for the ENRICH program

ENRICH 计划的科罗拉多州护士家庭心脏试验

基本信息

批准号：
10426544
负责人：
Mandy Atlee Allison
金额：
$ 61.36万
依托单位：
UNIVERSITY OF COLORADO DENVER
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/10426544
关键词：
Address Adult Birth Blood Pressure Body Composition Body mass index Breastfed infant Cardiovascular Diseases Cause of Death Characteristics Child Child Abuse and Neglect Child Rearing Cholesterol Clinic Cognitive Colorado Consolidated Framework for Implementation Research Data Development Diet Discipline of Nursing Disease Dose Early Intervention Economics Education Effectiveness Employment Family Nursing Family Planning Fathers Fetal Development Glucose Health Health Insurance Health Promotion Healthcare Systems Healthy Eating Heart Home Home visitation Income Individual Infant Care Injury Intervention Life Low income Marriage Maternal and Child Health Measures Mental Health Methods Modeling Mothers Nulliparity Nurses Outcome Participant Persons Pilot Projects Population Postpartum Period Pregnancy Pregnant Women Procedures Process Program Acceptability Protocols documentation Reporting Request for Applications Resources Safety Smoking Social Network Time Unemployment United States Visiting Nurse Weight Weight Gain Woman acceptability and feasibility active lifestyle cardiovascular disorder risk cardiovascular health critical period design diabetes prevention program early pregnancy effectiveness implementation study effectiveness implementation trial ethnic minority evidence base health of the mother implementation intervention improved infancy intergenerational intervention delivery lifestyle intervention offspring pregnancy hypertension prenatal primary outcome programs racial and ethnic recruit reproductive response safety net smoking cessation smoking exposure social health determinants treatment as usual young woman

项目摘要

PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death in the United States, with disparately greater impact on racial/ethnic minorities and lower-income individuals. Risk for CVD begins very early in life as adverse exposures during critical periods (fetal development, infancy, and reproductive years) shift the health trajectory toward overt disease. Thus, efforts to promote and maintain cardiovascular health (CVH) from pregnancy onward are crucial to reducing the intergenerational burden of CVD. In response to the Early Intervention to Promote Cardiovascular Health of Mothers and Children request for applications (ENRICH RFA), we propose to leverage two widely-available interventions to promote CVH in diverse, under-resourced pregnant women and offspring: Nurse Family Partnership (NFP) and the National Diabetes Prevention Program (NDPP). NFP is a home visiting program in which nurses support first-time, under-resourced mothers from pregnancy to 24 months postpartum to improve prenatal outcomes, child safety and developmental outcomes, and economic self-sufficiency. NFP is available at >260 organizations nationwide, including our Denver Health partners who have delivered it to >2400 urban, under-resourced women since 2000. While NFP addresses some putative causes of compromised maternal and child health, CVH has not been comprehensively addressed nor evaluated. Thus, we propose to enhance NFP with CVH-focused programming adapted from the NDPP, a yearlong, evidence-based lifestyle intervention that promotes healthy eating and activity to reduce weight, dysglycemia, and other CVD risks, which we have delivered to >1600 diverse, under-resourced adults at Denver Health since 2013, including >340 young women. By leveraging unique strengths of NFP (home delivery model, professional nursing support, impact on social determinants of health [SDOH]) with those of NDPP (evidence-based content for CVH promotion), a combined intervention (NFP-Heart) rigorously evaluated in the ENRICH program has great potential to improve CVH outcomes in under-resourced populations. Our Colorado Nurse Family Heart Trial will evaluate NFP-Heart versus usual care among 600 nulliparous women (and their offspring) recruited in early pregnancy from 10 clinics in a safety-net, urban healthcare system. NFP-Heart will promote intergenerational CVH with programming delivered from 20 weeks gestation to 24 months postpartum by home visiting nurses. Our specific aims are 1) develop the local NFP-Heart and common ENRICH protocols, and conduct pilot studies to confirm feasibility and acceptability; 2) evaluate the effect of NFP-Heart on maternal and offspring CVH metrics; 3) assess the degree to which SDOH modify the effect of the NFP-Heart intervention on maternal and offspring CVH outcomes; and 4) examine the implementation of the NFP-Heart intervention and potential for sustainability using a mixed- methods approach.

项目摘要心血管疾病（CVD）是美国死亡的主要原因，影响较大关于种族/族裔少数民族和低收入个人。 CVD的风险在生活中很早就开始了在关键时期（胎儿发育，婴儿期和生殖年）的暴露改变了健康轨迹面向明显的疾病。因此，从怀孕开始促进和维持心血管健康（CVH）的努力对于减轻CVD的代际负担至关重要。回应早期干预以促进母亲和儿童的心血管健康请求申请（富集RFA），我们建议利用两项广泛可用的干预措施，以促进各种资源，资源不足的孕妇和后代的CVH：护士家庭伙伴关系（NFP）和国家糖尿病预防计划（NDPP）。 NFP是一个家访问护士在产后从怀孕到24个月的首次支持，资源不足的母亲的计划改善产前结果，儿童安全和发展成果以及经济自给自足。 NFP是全国> 260个组织可用，包括我们将其交付到> 2400的丹佛健康伙伴自2000年以来，城市资源不足的妇女。尽管NFP解决了一些推定的原因。孕产妇和儿童健康，CVH尚未经过全面解决或评估。因此，我们建议使用以CVH为重点的编程来增强NFP 促进健康饮食和活动以减轻体重，血糖和其他CVD风险的干预措施，这些风险自2013年以来，我们已向丹佛健康（Denver Health）提供了> 1600种不同的，资源不足的成年人，其中包括340岁女性。通过利用NFP的独特优势（送货上门模型，专业护理支持，对健康的社会决定因素[SDOH]）与NDPP的社会决定因素（CVH促销的循证内容）在富集计划中严格评估的合并干预（NFP-Heart）具有改进的巨大潜力资源不足的人群的CVH结果。我们的科罗拉多州护士家庭心脏病试验将评估NFP-Heart 在怀孕早期从10个诊所招募的600名无效妇女（及其后代）中，在10个诊所中的治疗与通常的护理在安全网中，城市医疗保健系统。 NFP-Heart将通过编程促进代际CVH 由家庭访问护士从20周的妊娠到产后24个月。我们的具体目标是1）制定局部NFP-Heart和常见的丰富协议，并进行试验研究以确认可行性和可接受性； 2）评估NFP-Heart对母亲和后代CVH指标的影响； 3）评估学位 SDOH改变了NFP心脏干预对母亲和后代CVH结果的影响；和 4）检查使用混合 - 方法方法。