A Randomized Control Trial of a Culturally Relevant Maternal Wellness App to Improve Black Maternal Mental Health Outcomes

一项与文化相关的孕产妇健康应用程序的随机对照试验，以改善黑人孕产妇心理健康结果

• 批准号: 10593841
• 负责人: Eynav Elgavish Accortt
• 金额: $ 20.88万
• 依托单位: CEDARS-SINAI 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: 2022-09-27 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10593841
• 关键词: Address; Adherence; Advocacy; Advocate; Anxiety; Anxiety Disorders; Automobile Driving; Behavioral; Biological; Biological Testing; Birth; Black race; Blood; C-reactive protein; COVID-19; CREB1 gene; Caring; Child; Childbirth; Clinical; Clinical effectiveness; Communication; Communication Barriers; Communities; Community Networks; Complication; Control Groups; Coupled; Data; Diagnosis; Diagnostic; Discrimination; Education; Etiology; Functional disorder; Gene Expression Profile; Genes; Gestational Diabetes; Goals; Health; Healthcare; Healthy People 2020; Inflammation; Inflammatory; Intervention; Knowledge; Laws; Light; Los Angeles; Low Birth Weight Infant; Maternal Health; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Minority; Mobile Health Application; Mood Disorders; Mothers; Multi-Institutional Clinical Trial; Outcome; Participant; Patients; Perinatal; Physicians; Physiological; Population; Positioning Attribute; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnant Women; Prevalence; Primary Health Care; Provider; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Proposals; Risk; Risk Factors; Role; Small for Gestational Age Infant; Source; Spottings; Stress; Structure; Symptoms; Techniques; Telemedicine; Testing; Visit; Well in self; Woman; Work; adverse outcome; base; black patient; black women; clinical care; comparison intervention; cultural competence; design; differential expression; effective intervention; experience; follow-up; group intervention; health disparity; health equity; improved; improved outcome; insight; jun Oncogene; mHealth; minority patient; novel; online care; perinatal mental health; perinatal outcomes; perinatal period; physical conditioning; physical symptom; premature; prenatal; prevent; prospective; psychoeducation; public health relevance; racial disparity; racism; screening; self help; skills; standard of care; stress management; support network; systemic inflammatory response; transcription factor; virtual; women of color

Project Summary/Abstract Perinatal Mood and Anxiety Disorders (PMADs) encompass a range of mental health disorders that occur during pregnancy and up to one year postpartum. Approximately 13% of women experience PMADs. This rate doubles for those with adverse perinatal outcomes (APO) and triples in Black women. Recent research points to racism as one significant source of these health disparities. Cultural adaptations to improve communication with providers decrease rates of depression in minority patients as well as improve adherence to treatment, insight and alliance. Discrimination stress and worries about experiencing medical consequences are thought to increase systemic inflammation, a mechanism known to drive mental and physical symptoms. Inflammation has been implicated in both PMADs and APO, suggesting a shared underlying etiology. Evidence from our work suggests that inflammation contributes to the pathophysiology of PMADs. The proposed pilot randomized control trial will allow us to build on promising preliminary results and identify whether our culturally relevant mobile Health (mHealth) intervention is effective in improving outcomes among Black pregnant women randomized to the intervention compared to a control group. The culturally relevant modules include building communication and self-advocacy skills and provide a support network. The primary objective of this research is to provide guidance for clinical care of Black women during the perinatal period, with the goal to improve mental health and physical health outcomes. A secondary goal is to examine novel inflammatory signatures that change as a function of the intervention to reduce PMADs in this population. As inflammation may be diagnostic of PMADs, identification of its role may shed light of potential intervention targets and provide critical knowledge to improve women’s long-term health. PMAD symptoms will be assessed prospectively in 150 Black pregnant women, half of whom will be randomized to receive the culturally relevant mHealth intervention. We hypothesize that women in the intervention group will have reduced rates of PMADs and APOs, an increase in adherence to mental health treatment and will report increased self-advocacy skills, increased communication with providers, and reduced levels of discrimination related stress. They will also have improved biological risk indicators including lower circulating C-reactive protein and a transcription profile of differentially expressed inflammatory genes, marked by a decreased activity of inflammatory transcription factors from blood spots. Given the high burden of both PMADs and APOs among Black mothers and the numerous consequences on maternal and child outcomes, it is imperative that we develop and implement effective interventions, and test the biological mechanisms that might drive these effects. This work is interdisciplinary, building on a network of community advocates to implement a novel mHealth intervention informed by real world experiences designed to enhance self-advocacy, reduce stress and prevent adverse outcomes.

项目摘要/摘要 围产期情绪和焦虑症（PMADS）涵盖了一系列心理健康障碍 怀孕和产后一年。大约13％的女性体验PMAD。这个速率翻了一番 对于那些在黑人妇女中患有不良围产期结果（APO）和三倍的人。最近的研究指出了种族主义 作为这些健康差异的重要来源。文化适应以改善与 提供者降低少数族裔患者的抑郁率，并提高对治疗的依从性，洞察力 和联盟。认为歧视压力和对经历医疗后果的争执被认为是 增加全身感染，这种机制已知可以驱动精神和身体症状。炎症有 我们参与了PMAD和APO，这表明了共享的潜在病因。我们工作的证据 表明炎症有助于PMAD的病理生理学。提议的飞行员随机控制 试验将使我们能够以有希望的初步结果为基础，并确定我们与文化相关的移动 健康（MHealth）干预可有效改善随机分配的黑人孕妇的预后 与对照组相比，干预措施。与文化相关的模块包括建筑通信 和自我倡导技能并提供支持网络。这项研究的主要目的是提供 在围产期期间，黑人妇女的临床护理指南，目的是改善心理 健康和身体健康结果。第二个目标是检查新颖的炎症特征 这种变化是减少该人群中PMAD的干预措施的函数。因为注射可能是 PMAD的诊断，其作用的识别可能会阐明潜在的干预目标并提供关键 知识以改善妇女的长期健康。 PMAD符号将在150黑色的前瞻性评估 孕妇，其中一半将被随机接受与文化相关的MHealth干预措施。我们 假设干预组中的女性将降低PMAD和APO的比率，从而增加 遵守心理健康治疗，并将报告提高的自我顾问技能，提高沟通 提供者和歧视相关压力的水平降低。他们还将有改善的生物风险 指标包括较低的循环C反应蛋白和不同表达的转录曲线 炎症基因，以血液点炎症转录因子的活性减少。给出 黑人母亲中PMAD和APO的高燃烧以及对母亲的众多后果 和孩子的结果，我们必须开发和实施有效的干预措施，并测试生物学 可能会驱动这些影响的机制。这项工作是跨学科的，建立在社区网络上 倡导者实施一种新型的MHealth干预措施，该干预措施是由旨在增强的现实世界经验所告知的 自我倡导，减轻压力并防止不利的结果。