PARITY: An integrated community care and strengths-based technology intervention to improve maternal wellness and reduce health disparities in Black women

平等：综合社区护理和基于优势的技术干预，以改善孕产妇健康并减少黑人妇女的健康差距

• 批准号: 10701116
• 负责人: Elizabeth K Mollard
• 金额: $ 15.35万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701116
• 关键词: Address; Adherence; Affect; Behavior; Behavioral; Birth; Black Populations; Black race; Buffers; Caring; Centers for Disease Control and Prevention (U.S.); Cesarean section; Clinical; Clinical Trials; Communities; Community Health Aides; Complex; Cost Savings; Data Collection; Enrollment; Evaluation; Exercise; Goals; HELLP Syndrome; Health Care Costs; Health Insurance Portability and Accountability Act; Healthcare; Human; Hypertension; Individual; Informal Social Control; Intervention; Investments; Maternal Health; Maternal Mortality; Measures; Mediating; Medical; Methods; Modeling; Motivation; Nurse Midwives; Outcome; Participant; Physical activity; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnant Women; Problem Solving; Public Health; Reduce health disparities; Research; Research Methodology; Resources; Risk; Self Efficacy; Sleep; Social Conditions; Social support; Structure; Supportive care; Surveys; Technology; Testing; Time; United States; Woman; Work; barrier to care; base; behavioral outcome; black women; clinical practice; community center; community engagement; community setting; concept mapping; empowered; experience; health care availability; health care model; health care quality; health disparity; healthy pregnancy; improved; innovation; insight; intervention participants; lens; maternal morbidity; maternal outcome; member; mobile computing; mortality; new technology; novel; nutrition; peer; perinatal health; pilot test; pregnancy disorder; pregnancy hypertension; pregnant; prenatal; primary outcome; programs; protective effect; protective efficacy; racism; randomized trial; resilience; response; secondary outcome; severe maternal morbidity; social; theories

Project Summary In the United States, excessive rates of maternal morbidity and mortality are a public health crisis borne disproportionately by Black women. Decades of research have failed to ameliorate this crisis. Most research involving Black maternal morbidity and mortality is structured according to a deficit-focused framework, which highlights the deficiencies and insufficiencies of individuals within the examined community. Clinical practices resulting from such research normalize and blame individuals for the maternal health disparities that Black women experience. This proposal addresses maternal morbidity and mortality and the impact of deficit-focused health care models on maternal health by leveraging the protective assets of Black communities and individuals, use of integrated supportive care, and a wellness-based mobile technology intervention to reduce maternal morbidity, mortality, and cesarean birth and improve wellness-related behavioral outcomes. Our goal is to offer pragmatic, community-centered solutions to maternal health disparities that build upon the inherent strengths of Black individuals and Black communities . Based on our theory of maternal adaptive capacity and building upon our previous work, we have developed a novel program called Protective Assets Reinforced with Integrated care and TechnologY (PARITY). We propose a randomized trial and mixed methods evaluation involving 384 Black pregnant women, divided between PARITY program participants and information control (IC). Our innovative, community-based intervention will identify the strengths and protective assets of intervention participants and of their communities. Within the community setting, PARITY participants are matched with Black doulas who will provide strengths-based guidance, support, and community resources throughout the pregnancy continuum. PARITY participants will also use a novel HIPAA compliant mobile technology platform that promotes wellness behaviors, empowered strengths, and healthcare adherence while offering additional opportunities to connect with the community-based doula. The specific aims of this proposal are: (1) Determine the effects of the PARITY program, as compared to IC, on severe maternal morbidity (primary outcome), maternal mortality, and cesarean birth (secondary outcomes) in Black pregnant women; (2) Determine the effects of the PARITY program on wellness-related behavioral outcomes including nutrition, physical activity, sleep, and healthcare adherence; (3) Assess whether changes in maternal outcomes are mediated by changes in wellness-related behavioral outcomes and whether the effects of PARITY on the wellness-related behavioral outcomes are mediated by changes in empowered strengths; and (4) Identify barriers, facilitators, and perceived benefits of the PARITY intervention. The proposed research offers a comprehensive, innovative approach to maternal morbidity and mortality reduction by integrating a strengths-based framework, novel technology, and peer-based community support, while addressing healthcare access, healthcare quality, and the social needs of each participant.

项目概要 在美国，过高的孕产妇发病率和死亡率是一场公共卫生危机 黑人女性所占比例不成比例。数十年的研究未能缓解这场危机。大多数研究 涉及黑人孕产妇发病率和死亡率的问题是根据以赤字为重点的框架构建的， 这凸显了受审查社区内个人的缺陷和不足。临床 此类研究产生的做法使孕产妇健康差异正常化并归咎于个人 黑人女性所经历的。该提案涉及孕产妇发病率和死亡率以及孕产妇发病率和死亡率的影响 利用黑人的保护性资产，针对孕产妇健康建立以赤字为重点的医疗保健模式 社区和个人、综合支持性护理的使用以及基于健康的移动技术 旨在降低孕产妇发病率、死亡率和剖腹产并改善与健康相关的干预措施 行为结果。我们的目标是为孕产妇健康提供务实、以社区为中心的解决方案 建立在黑人个人和黑人社区固有优势之上的差异。基于我们的 母亲适应能力理论并在我们之前的工作的基础上，我们开发了一种新颖的 名为“综合护理和技术强化保护性资产”(PARITY) 的计划。我们提出一个 随机试验和混合方法评估，涉及 384 名黑人孕妇，分为 PARITY 计划参与者和信息控制（IC）。我们以社区为基础的创新干预措施将确定 干预参与者及其社区的优势和保护性资产。内 社区设置中，PARITY 参与者会与黑人导乐相匹配，后者将根据优势提供服务 整个怀孕过程中的指导、支持和社区资源。 PARITY 参与者将 还使用符合 HIPAA 标准的新型移动技术平台来促进健康行为， 增强优势和医疗保健依从性，同时提供额外的机会与 以社区为基础的导乐。该提案的具体目标是： (1) 确定 PARITY 的效果 与 IC 相比，该计划在严重孕产妇发病率（主要结果）、孕产妇死亡率和剖宫产方面 黑人孕妇的出生（次要结果）； (2) 确定 PARITY 程序对 健康相关的行为结果，包括营养、体力活动、睡眠和医疗保健依从性； (3) 评估孕产妇结局的变化是否是由健康相关行为的变化引起的 结果以及 PARITY 对健康相关行为结果的影响是否由以下因素介导 授权优势的变化； (4) 识别 PARITY 的障碍、促进因素和可感知的好处 干涉。拟议的研究提供了一种全面、创新的方法来解决孕产妇发病率和 通过整合基于优势的框架、新技术和基于同伴的社区来降低死亡率 支持，同时解决医疗保健获取、医疗保健质量和每个参与者的社会需求。