Healthy Beyond Pregnancy: Leveraging Behavior Economics to Improve Postpartum Care

怀孕后的健康：利用行为经济学改善产后护理

• 批准号: 9913829
• 负责人: Katherine P Himes
• 金额: $ 28.97万
• 依托单位: MAGEE-WOMEN'S RES INST AND FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-17 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913829
• 关键词: Address; Adherence; Attention; Awareness; Behavioral; Birth; Birth Intervals; Breast Feeding; Cardiovascular Diseases; Caring; Chronic Disease; Contraceptive methods; Contracts; Data; Diabetes Mellitus; Economically Deprived Population; Economics; Education; Enrollment; Exposure to; Foundations; Gestational Diabetes; Health; Healthcare; Hepatitis C; High Risk Woman; Hypertension; Incentives; Income; Inequality; Infant; Insurance Carriers; Intervention; Knowledge; Lead; Longterm Follow-up; Maternal and Child Health; Maternity Hospitals; Measures; Medicaid; Medical; Modeling; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Online Systems; Outcome; Patients; Postpartum Period; Postpartum Women; Pragmatic clinical trial; Pregnancy; Pregnancy Complications; Pregnancy Interval; Premature Birth; Prenatal care; Primary Health Care; Principal Investigator; Randomized; Randomized Controlled Trials; Research; Research Personnel; Risk; Sample Size; Self-control as a personality trait; Subgroup; Testing; Text Messaging; Visit; Woman; arm; attentional control; base; behavioral economics; cardiometabolism; cationic antimicrobial protein CAP 37; combat; design; diabetic; dissemination trial; economic behavior; efficacy trial; experience; feasibility trial; financial incentive; follow-up; health disparity; health plan; high risk; improved; innovation; interest; medical specialties; multidisciplinary; neonatal death; novel; personalized approach; pilot trial; postpartum care; postpartum weight; pregnant; programs; recruit; screening; secondary outcome; tool; treatment arm; trend; unintended pregnancy; uptake; usability; visit adherence; willingness

PROJECT SUMMARY There are striking inequalities by income level in important maternal child health outcomes, including rates of unintended pregnancies, breastfeeding duration and preventative or specialty health care uptake after delivery. The long-term health consequences of these disparities are well documented. An important, but under studied contributor to these health disparities is adherence to postpartum care. High quality postpartum care targets immediate and long-term maternal and child health needs through provision of contraception, support for breastfeeding, screening for cardio-metabolic complication of pregnancy and linkage to care for high-risk women. Adherence with the postpartum visit among economically disadvantaged women, however, is poor. The disparity in rates of postpartum care demonstrates that the current care model does not engage all women and disproportionately fails our most vulnerable mothers and babies. The overarching hypothesis of our research agenda is that an intervention grounded in empirically derived concepts of behavioral economics will improve compliance with the postpartum visit and promote equality in maternal child health. To this end, we have designed an innovative, scalable, and affordable web-based solution- Healthy Beyond Pregnancy. Healthy Beyond Pregnancy uses proven tenets of behavioral economics to target two critical drivers of behavioral change-- awareness and willingness. The four cornerstones of our program are: (1) combating information overload with a personalized approach to postpartum education and care, (2) overcoming self-control issues by formalizing the postpartum visit with a commitment contract, (3) addressing limited attention and increasing awareness by nudging women in the immediate postpartum period via automated text messaging and (4) incentivizing completion of the postpartum visit. Our web-based platform is built, usability testing is complete, and we successfully performed a pilot feasibility trial demonstrating our ability to recruit and enroll subjects at a rate needed for this application. Our next objective-- the focus of this proposal-- is to conduct a pragmatic clinical trial to test our hypothesis that exposure to HBP will result in a 30% increase in compliance with the postpartum visit and in turn lead to measureable improvements in uptake of effective contraception, breastfeeding duration, and linkage of care for high-risk women. We have assembled a multi-disciplinary team with the knowledge and expertise necessary for this project. We have also engaged the UPMC Health Plan, an important stakeholder, as they are the largest insurer of economically disadvantaged pregnant patients in our busy maternity hospital, to support this scientific endeavor. Successful completion of our aims will provide the foundation for a dissemination trial with the primary objective of narrowing the gap in short-interval pregnancies, short breastfeeding duration and inadequate follow-up after complicated pregnancy.

项目摘要 重要的母亲儿童健康成果中的收入水平存在惊人的不平等现象，包括 分娩后意外怀孕，母乳喂养持续时间以及预防或专业的医疗保健。 这些差异的长期健康后果已得到充分记录。一个重要的，但研究了 这些健康差异的贡献是遵守产后护理。 高质量的产后护理针对立即和长期的母亲和儿童健康需求 提供避孕，母乳喂养的支持，筛查心脏代谢并发症的妊娠并发症 和关注高风险女性的联系。在经济上遵守产后访问 但是，处境不利的妇女很差。产后护理率的差异表明 当前的护理模型并不吸引所有妇女，并且不成比例地使我们最脆弱 母亲和婴儿。 我们研究议程的总体假设是，以经验得出的为基础的干预措施 行为经济学的概念将改善对产后访问的遵守，并促进平等 产妇儿童健康。为此，我们设计了一种创新，可扩展和负担得起的基于网络的 解决方案 - 健康之外的健康。健康超越怀孕的使用已证明的行为经济学原则 针对两个关键的行为改变驱动力 - 意识和意愿。我们的四个基石 计划是：（1）用个性化的产后教育和 护理，（2）通过承诺合同正式化产后访问来克服自我控制问题，（3） 通过在产后立即推动妇女来解决有限的关注和提高意识 通过自动文本消息传递和（4）激励产后访问的完成。我们基于网络的平台 是构建的，可用性测试已经完成，我们成功地进行了一项飞行员的可行性试验，证明了我们的 能够以本应用所需的速度招募和注册受试者。我们的下一个目标 - 该建议 - 是进行务实的临床试验，以检验我们的假设，即接触HBP 导致符合产后访问的30％，进而导致可衡量的 改善有效避孕，母乳喂养持续时间和护理连接的摄入 高风险女性。我们已经组建了一个具有必要的知识和专业知识的多学科团队 对于这个项目。我们还参与了重要的利益相关者UPMC健康计划，因为他们是 在我们繁忙的产妇医院，最大的经济弱势孕妇保险公司以支持这一点 科学努力。成功完成我们的目标将为与 缩小短间隔妊娠的差距，短期母乳喂养持续时间和 复杂怀孕后的随访不足。