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：
9272413
负责人：
Liwei Chen
金额：
$ 58.86万
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/9272413
关键词：
37 weeks gestation Achievement 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 Eligibility Determination Etiology Gestational Age Goals 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 public health relevance 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（由申请人提供）：在美国，早产 (PTB) 的发生率高得令人无法接受，其中黑人女性受到的影响尤为严重，迄今为止，医疗和公共卫生干预措施在改善出生结局方面取得的成功有限。问题可能在于，过去几十年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，包括行为、社会心理、社会人口、社区、环境和医疗。怀孕期间的心理社会因素（例如压力、焦虑、抑郁和应对反应）作为导致不良分娩结果的关键因素而受到越来越多的关注，如果不全面解决这些更广泛的因素，干预措施可能不太可能取得成功。 CenteringPregnancy 团体产前护理 (GPNC) 的研究将个人身体评估与促进的团体教育和同伴支持相结合，已显示出可喜的结果，包括较高的产前护理使用率和护理满意度，以及 PTB 率的提高，因为 GPNC 提供了社会服务。支持以及更多的就诊时间、加强患者教育、自我护理技能和赋权，它认为改善出生结果和减少出生结果种族差异的巨大潜力然而，尚未有研究最终确定 GPNC 对 PTB 的总体影响，或者这种护理模式对 PTB 种族差异的影响也尚未确定。 GPNC 对患者教育、激活和压力的影响，可能会影响出生结果以及产后期的健康行为和结果。为了填补这一研究空白，我们建议进行一项随机对照试验 (RCT) 来比较生物医学、行为学。该试验对参加 GPNC 的孕妇和接受传统个体产前护理 (IPNC) 的妇女进行了按种族划分的心理社会结果，并调查改善妇女的压力、激活和参与是否可以解释 GPNC 对结果和健康差异的潜在益处。将进行在南卡罗来纳州的一家大型产前护理中心，历史 PTB 率高达 16.4%，符合条件的白人和黑人妇女将在孕龄 20 周之前被招募，并在分娩后和产后 6 周进行随访。