Food for LifecOURse equity In maternal Security and Health

孕产妇安全与健康中的食品促进生命全程公平

基本信息

批准号：
10748848
负责人：
Emily Jean Jones
金额：
$ 49.7万
依托单位：
UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-17 至 2030-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10748848
关键词：
Acculturation Address Affect Alaska Native American Indians Behavior Behavioral Biological Biological Markers Birth Child Childbirth Chronic Collaborations Communities Community Health Community Healthcare Data Decision Making Diabetes Mellitus Diagnosis Diet Dietary intake Discrimination Disparity Educational Curriculum Ensure Equation Equity Evaluation Excision Family Feedback Female of child bearing age Focus Groups Food Gestational Diabetes Glycosylated hemoglobin A Group Interviews Health Health Food Health Personnel Healthcare High Prevalence High-Risk Pregnancy Home Homicide Household Hypertension Immune Indigenous Inflammation Influentials Intervention Interview Involuntary Sterilization Kansas Lactation consultant Life Cycle Stages Link Live Birth Managed Care Maternal Health Maternal Health Services Maternal health equity Measures Medicine Midwife Modeling Morbidity - disease rate Mothers Native Americans Needs Assessment Nutrient Nutrition Assessment Nutritional Obesity Observational Study Oklahoma Outcome Participant Pathway interactions Pattern Perinatal Personal Satisfaction Physical activity Population Postpartum Depression Postpartum Period Pre-Eclampsia Pregnancy Pregnancy Complications Premature Birth Prenatal care Prevalence Prevention Provider Randomized Recording of previous events Reporting Research Research Design Risk Risk Behaviors Risk Factors Security Self Care Self-Injurious Behavior Series Sleep Social support Source Stress Stressful Event Suicide Support System Surveys Testing Texas Trauma Tribes Victimization Violence Well in self Woman adverse childhood events cardiometabolic risk cardiometabolism care giving burden care providers comorbidity comparison group cultural health design dietary dietary manipulation experience follow-up food insecurity food security gender-based violence gestational weight gain group intervention health care availability health care service utilization health inequalities high risk indigenous community intergenerational intimate partner violence maternal morbidity maternal safety maternal stress maternal wellbeing motherhood nutrition parous perceived stress pregnancy disorder pregnant prepregnancy primary outcome recruit resilience rural area secondary outcome severe maternal morbidity social social health determinants stress management stress reduction structural determinants substance use theories tribal community tribal health whole health

项目摘要

Project Summary / Abstract The Food for LifecOURse equity In maternal Security and Health (FLOURISH) Study uses a cross-cutting research design that is widely-applicable to the prevention and treatment of many chronic co-morbidities that disproportionately affect Indigenous women of childbearing age. Through intentional engagement with community stakeholders across all project years, diverse perspectives will be integrated into the research strategy and aims to ensure study findings are relevant, actionable, and yield the greatest potential for reducing health inequities. Broadly, FLOURISH will elucidate nutritional and non-nutritional behavioral risk pathways linking food insecurity to severe maternal morbidity (SMM) and related outcomes among Indigenous women during pregnancy and the immediate post-partum period. A primary focus will be the impact of trauma on food insecurity and health risk, as well as the rigorous evaluation and manipulation of dietary intake as an influential pathway, with a special focus on dietary quality, chronic inflammation and dysglycemia. The study will be conducted in Oklahoma, which is home to 39 of the federally-recognized Tribes that comprise the Southern Plains region, in collaborative partnership with the Southern Plains Tribal Health Board. It is comprised of three aims. First, the team will test and refine a conceptual integrated framework of food insecurity and SMM to identify significant structural, social, behavioral, and biological pathways as candidate intervention points. This aim will be accomplished through an observational study (n=350) of pregnant Indigenous women followed to 3-months postpartum. Structural equation modeling will be used to test the study’s overall conceptual multi-level framework of food insecurity and SMM. The final model will be refined through input with community stakeholders. Second, the community-academic research team will develop the FLOURISH intervention, to be adapted from perinatal food is medicine models used in non-Indigenous populations, with an emphasis on whole person health, including stress management and self-care. The FLOURISH intervention will strategically address key nutrition disparities and other health risk behaviors identified as significant path contributors to various drivers of SMM in this specific population. This adaptation will be informed by findings from the first aim, and further refined and finalized through a series of interviews groups with primiparous and multiparous Indigenous women with history of SMM and various community care providers for this population (n=36). A series of focus groups with intended users will solicit final feedback before the intervention is launched. Third, the research team will use a randomized parallel group design (n=150) involving an additional external control comparison group to test the FLOURISH and FLOURISH PLUS (including community healthcare workers) interventions to assess for feasibility, acceptability, and preliminary impact. Participants will be stratified by pre-pregnancy cardiometabolic risk (high versus low). Primary outcomes include excess gestational weight gain with multiple secondary outcomes (prenatal care, post-partum depression, stress, food security, dietary quality, inflammation, and hemoglobin A1c).

项目概要/摘要孕产妇安全与健康中的食品促进生命全程公平（FLOURISH）研究采用了跨领域研究广泛适用于预防和治疗许多慢性合并症的研究设计通过有意接触，对育龄土著妇女产生了不成比例的影响。所有项目年份的社区利益相关者，不同的观点将融入研究中战略和目标，以确保研究结果具有相关性、可操作性，并产生最大的潜力来减少总体而言，FLOURISH 将阐明营养和非营养行为风险途径。将粮食不安全与土著妇女的严重孕产妇发病率 (SMM) 及相关结果联系起来怀孕期间和产后期间的主要关注点是创伤对食物的影响。不安全感和健康风险，以及对饮食摄入量的严格评估和控制作为影响因素该研究将特别关注饮食质量、慢性炎症和血糖异常。俄克拉荷马州是 39 个联邦认可部落的所在地，其中包括南方部落平原地区，与南部平原部落卫生委员会合作，由三个部分组成。首先，该团队将测试和完善粮食不安全和 SMM 的概念综合框架，以确定重要的结构、社会、行为和生物途径作为候选干预点。通过对怀孕的土著妇女进行为期 3 个月的观察性研究（n=350）来完成产后结构方程模型将用于测试该研究的整体概念多层次框架。最终模型将通过社区利益相关者的意见进行完善。社区学术研究团队将开发 FLOURISH 干预措施，以适应围产期非原住民使用的食物即药物模型，强调整体健康， FLOURISH 干预措施将战略性地解决关键营养问题。差异和其他健康风险行为被认为是 SMM 各种驱动因素的重要路径贡献者这一特定人群将根据第一个目标的发现进行调整，并进一步完善和改进。通过对有历史的初产和多产土著妇女进行一系列访谈小组最终确定 SMM 和针对该人群的各种社区护理提供者 (n=36) 的一系列焦点小组。第三，研究团队将使用随机方法。平行组设计（n = 150），涉及额外的外部对照比较组来测试 FLOURISH 和 FLOURISH PLUS（包括社区医护人员）干预措施以评估可行性，可接受性和初步影响将根据孕前心脏代谢风险（高）对参与者进行分层。主要结局包括妊娠期体重过度增加以及多种次要结局（产前护理、产后抑郁、压力、食品安全、饮食质量、炎症和血红蛋白 A1c）。