Exploring the Preliminary Efficacy of Centering Pregnancy with Care Navigation to Reduce Maternal Health Disparities among Marshallese Women

探索以怀孕为中心的护理导航减少马绍尔妇女孕产妇健康差异的初步效果

• 批准号: 10708990
• 负责人: Britni Lee Ayers
• 金额: $ 22.95万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10708990
• 关键词: Appointment; Arkansas; Behavior Therapy; Birth; Birth Records; Caring; Cesarean section; Coupled; Data; Effectiveness; Emergency department visit; Enrollment; Food; Foundations; Gestational Diabetes; Health Insurance; Health Priorities; Housing; Improve Access; Infant; Infant Health; Infant Mortality; Insurance; Intervention; Literature; Live Birth; Low Birth Weight Infant; Maintenance; Maternal Age; Maternal Health; Maternal Mortality; Measures; Medical Records; Methods; Migrant; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Pacific Islander; Participant; Patient-Focused Outcomes; Population; Postpartum Period; Pre-Eclampsia; Pregnancy; Premature Birth; Prenatal care; Prevention; Recommendation; Reporting; Research Institute; Resources; Services; Social support; Supportive care; Testing; Transportation; United States; United States National Institutes of Health; Visit; Woman; comparison group; ethnic minority; experience; gestational weight gain; global health; health disparity; health inequalities; high risk; improved; infant morbidity; infant morbidity/mortality; maternal morbidity; mortality; parity; perinatal outcomes; postpartum care; prenatal; programs; public health relevance; racial minority; social culture; sociodemographics

Abstract Pacific Islanders residing in the United States (US) have disproportionally high rates of preterm birth (<37 weeks) and low birthweight infants (<2,500 grams). They are also more likely to experience preeclampsia, primary cesarean birth, excessive gestational weight gain, and gestational diabetes mellitus (GDM) compared to other racial/ethnic minorities and the US population in general. These maternal health factors serve as precursors to maternal and infant morbidity and mortality. Pacific Islanders have almost twice the infant mortality rate, per 1,000 live births, as compared to non-Hispanic whites and have a higher maternal mortality rate compared to non-Hispanic whites (13.5 verse 12.7). Early and consistent supportive care throughout the pregnancy continuum is strongly associated with positive birth outcomes and is a global health priority. However, Pacific Islanders are less likely to receive adequate prenatal and postpartum care and are thus at a higher risk for maternal and infant morbidity and mortality. Emerging literature suggests that group-based prenatal programs, like Centering Pregnancy, coupled with care navigation, can mitigate precursors to severe morbidity and mortality such as: inadequate prenatal and postpartum care appointment attendance, preterm birth, low-birth weight infants, cesarean deliveries, emergency department visits, and access to social support services. However, group prenatal care with care navigation has not been tested with the Marshallese or other Pacific Islanders in the US. The proposed study will determine the feasibility of Centering Pregnancy with care navigation and the preliminary effectiveness to improve: prenatal and postpartum care appointment attendance, preterm birth, low-birth weight infants, cesarean deliveries, emergency department visits, and access to social support services. We will use a mixed- method approach with two groups of Marshallese women (propensity score matched on relevant covariates such as maternal age, parity, and sociodemographics), one group in Centering Pregnancy with care navigation and one group from standard prenatal care. The study will yield much-needed data on the feasibility of Centering Pregnancy with care navigation and the preliminary effectiveness to improve maternal health outcomes and supportive care with care navigators in an understudied population. Information from this study will provide the foundation to collaboratively test multilevel behavioral interventions to improve maternal and morbidity and mortality prevention efforts among Pacific Islanders, in a larger NIH R01 or Patient Centered Outcomes Research Institute trials.

抽象的 居住在美国 (US) 的太平洋岛民的早产率异常高 (<37 周）和低出生体重婴儿（<2,500 克）。他们也更有可能患有先兆子痫， 初次剖腹产、妊娠期体重过度增加和妊娠期糖尿病 (GDM) 的比较 其他种族/族裔少数群体和美国普通民众。这些孕产妇健康因素 孕产妇和婴儿发病率和死亡率的前兆。太平洋岛民的婴儿数量几乎是其两倍 与非西班牙裔白人相比，每 1,000 名活产婴儿的死亡率更高，孕产妇死亡率更高 与非西班牙裔白人相比（13.5 节 12.7）。整个过程中早期和持续的支持护理 连续妊娠与积极的分娩结果密切相关，是全球健康的优先事项。 然而，太平洋岛民不太可能获得足够的产前和产后护理，因此处于困境 孕产妇和婴儿发病率和死亡率的风险较高。 新出现的文献表明，基于群体的产前计划，如中心怀孕，加上 护理导航，可以减轻严重发病率和死亡率的先兆，例如：产前和护理不足 产后护理预约、早产、低出生体重儿、剖腹产、 急诊科就诊以及获得社会支持服务。不过，集体产前护理要细心 导航尚未在美国的马绍尔群岛或其他太平洋岛民中进行过测试。拟议的研究 将确定中心妊娠护理导航的可行性以及初步效果 改善：产前产后护理预约出勤率、早产、低出生体重儿、 剖腹产、急诊科就诊以及获得社会支持服务。我们将使用混合 两组马绍尔女性的方法方法（倾向评分与相关协变量相匹配） 例如产妇年龄、产次和社会人口统计学），通过护理导航集中怀孕的一组 一组来自标准产前护理。 该研究将产生急需的数据，说明通过护理导航进行中心妊娠的可行性以及 护理导航员在改善孕产妇健康结果和支持性护理方面取得了初步成效 未被充分研究的人群。这项研究的信息将为协作测试多层次提供基础 行为干预措施，以改善太平洋地区的孕产妇、发病率和死亡预防工作 岛民参与了一项更大的 NIH R01 或以患者为中心的结果研究所试验。