Reducing disparities in birth outcomes: a randomized controlled trial on CenteringPregnancy

减少出生结果的差异：关于 CenteringPregnancy 的随机对照试验

基本信息

批准号：
9119634
负责人：
Liwei Chen
金额：
$ 54.96万
依托单位：
CLEMSON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2020-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9119634
关键词：
Achievement Address Affect Anxiety Area Attention Behavior Behavioral Biological Birth Birth Rate Birth Weight Caring Cesarean section Chronic Disease Clinical Clinical Trials Communities Complex Economics Education Effectiveness Effectiveness of Interventions Etiology Gestational Age Goals Health Health behavior outcomes Healthcare Healthy Eating Individual Institute of Medicine (U.S.)Intervention Investigation Literature Longevity Low Birth Weight Infant Medical Mental Depression Modeling Neonatal Mortality Newborn Infant Observational Study Outcome Patient Education Patients Physical assessment Population Postpartum Period Pregnancy Pregnancy Complications Pregnant Women Premature Birth Prenatal care Provider Psychosocial Factor Public Health Race Randomized Controlled Trials Recruitment Activity Research Risk Role Selection Bias Self Care Services Smoking Social support South Carolina Stress Time United States Visit Woman behavioral outcome compare effectiveness coping cost design disability disparity reduction empowerment experience health disparity improved innovation medically underserved medically underserved population peer support prenatal stress primary care setting programs psychosocial public health intervention racial disparity response satisfaction skills success trial design underserved minority

项目摘要

DESCRIPTION (provided by applicant): Preterm birth (PTB) occurs at unacceptably high rates within the United States (U.S.), with Black women disproportionally affected. To date, medical and public health interventions have achieved limited success in improving birth outcomes. Part of the problem could be that the efforts in the last several decades focused mainly on increasing access to prenatal care. The etiology of birth outcomes is complex, involving behavioral, psychosocial, socio-demographic, community, environmental, and medical factors. Psychosocial factors during pregnancy (e.g. stress, anxiety, depression, and coping responses) are gaining increased attention as critical contributing factors to poor birth outcomes. Interventions that do not address these broader factors in a comprehensive way may be less able to achieve success. Studies of CenteringPregnancy group prenatal care (GPNC), where individual physical assessments are combined with facilitated group education and peer support, have demonstrated promising results, including high rates of prenatal care use and care satisfaction, and improvements in PTB rates. Because GPNC provides social support and more time for visits, increasing patient education, skills for self-care, and empowerment, it holds great potential for improving birth outcomes and reducing racial disparities in birth outcomes. However, no study has yet conclusively determined the effects of GPNC on PTB in general, or the effect of this care model on racial disparities in PTB. Prior research has also not established GPNC effects on patient education, activation, and stress, which may influence birth outcomes as well as health behaviors and outcomes beyond the postpartum period. To fill this research gap, we propose to conduct a randomized controlled trial (RCT) to compare biomedical, behavioral and psychosocial outcomes by race among pregnant women who participate in GPNC, to women in the traditional individual prenatal care (IPNC) and to investigate whether improving women's stress, activation and engagement will explain the potential benefits of GPNC on outcomes and health disparities. The trial will be conducted in a large prenatal care center in South Carolina where the historical PTB rate has been as high as 16.4%. Eligible White and Black women will be recruited before 20 weeks of gestational age and will be followed to delivery and 6 weeks postpartum.

描述（由适用提供）：早产（PTB）在美国（美国）以不可接受的高率发生，黑人妇女受到了不成比例的影响。迄今为止，医疗和公共卫生干预措施在改善出生结果方面取得了有限的成功。问题的一部分可能是，过去几十年中的努力主要集中在增加获得产前护理的机会。出生结果的病因很复杂，涉及行为，社会心理，社会人口统计学，社区，环境和医学因素。怀孕期间的社会心理因素（例如，压力，焦虑，抑郁和应对反应）正在增加关注，因为关键因素导致了不良的出生结果。无法以全面的方式解决这些更广泛因素的干预措施可能无法实现成功。对中心怀孕小组的产前护理（GPNC）的研究，将个人的身体评估与准备好的小组教育和同伴支持结合在一起，已经证明了有希望的结果，包括高产前护理的使用率和护理满意度的高率，以及PTB率的提高。由于GPNC提供社会支持和更多的访问时间，增加患者教育，自我保健和授权技能，因此改善出生成果和减少出生成果中的种族分布的巨大潜力。但是，尚无最终确定GPNC对PTB的影响，或该护理模型对PTB种族分布的影响。先前的研究也没有建立 GPNC对患者教育，激活和压力的影响可能会影响产后的出生结果以及健康行为和结果。为了填补这一研究差距，我们建议进行一项随机对照试验（RCT），以比较参加GPNC的孕妇，与传统个人产前护理（IPNC）中的妇女之间的种族进行比较生物医学，行为和心理社会成果，并研究了妇女的压力，激活和互动是否会改善GPNC上的妇女的益处，并改善了GPNC上的胜利和健康。该试验将在南卡罗来纳州的一个大型产前护理中心进行，该中心的历史PTB率高达16.4％。符合条件的白人和黑人妇女将在胎龄20周之前招募，并将遵循分娩和产后6周。