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.

项目概要心血管疾病 (CVD) 是美国的首要死因，其影响要大得多关于种族/族裔少数群体和低收入个人。 CVD 风险在生命早期就开始了关键时期（胎儿发育、婴儿期和生育期）的暴露会改变健康轨迹走向明显的疾病。因此，从怀孕开始就努力促进和维持心血管健康（CVH）对于减少 CVD 的代际负担至关重要。响应早期干预促进母亲和儿童心血管健康申请请求 (ENRICH RFA)，我们建议利用两种广泛使用的干预措施可促进多样化、资源不足的孕妇和后代的 CVH：护士家庭合作伙伴关系 (NFP) 和国家糖尿病预防计划 (NDPP)。 NFP是一次家访护士为资源不足的初次母亲提供从怀孕到产后 24 个月的支持的计划改善产前结果、儿童安全和发育结果以及经济自给自足。非农就业数据是全国超过 260 个组织均可使用，其中包括我们的 Denver Health 合作伙伴，他们已将其交付给超过 2400 个组织自 2000 年以来，城市、资源匮乏的女性受到了影响。虽然 NFP 解决了一些可能导致她们受到损害的原因，妇幼健康方面，CVH 尚未得到全面解决或评估。因此，我们建议通过改编自 NDPP 的以 CVH 为重点的规划来增强 NFP，这是一种为期一年的循证生活方式促进健康饮食和活动以减轻体重、血糖异常和其他心血管疾病风险的干预措施，自 2013 年以来，我们已为 Denver Health 的超过 1600 名多元化、资源不足的成年人提供服务，其中包括超过 340 名年轻人女性。通过利用 NFP 的独特优势（送货上门模式、专业护理支持、对健康的社会决定因素 [SDOH]）与 NDPP（促进 CVH 的循证内容）， ENRICH 计划中经过严格评估的联合干预措施（NFP-Heart）具有巨大的改善潜力资源贫乏人群的 CVH 结果。我们的科罗拉多州护士家庭心脏试验将评估 NFP-Heart 从 10 个诊所招募的 600 名怀孕早期的未产妇（及其后代）与常规护理的比较在安全网、城市医疗保健系统中。 NFP-Heart 将通过编程促进代际 CVH 从妊娠 20 周到产后 24 个月，由上门护士接生。我们的具体目标是 1) 制定本地 NFP-Heart 和通用 ENRICH 协议，并进行试点研究以确认可行性和可接受性； 2) 评估 NFP-Heart 对母体和后代 CVH 指标的影响； 3）评估学位 SDOH 改变了 NFP-Heart 干预对孕产妇和后代 CVH 结果的影响；和 4) 检查 NFP-Heart 干预措施的实施情况以及使用混合的可持续性潜力方法方法。