This is a randomized comparative effectiveness study of two forms of enhanced prenatal care among 657 Medi-Cal eligible pregnant individuals in Fresno, California. The goal is to see whether group prenatal care with wrap around services versus individual prenatal care supplemented by services covered by the California Department of Public Health Comprehensive Perinatal Services Program (CPSP) results in less depression and anxiety, and more respectful, more person-centered maternity care and lower rates of preterm birth.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
674
Glow! is an enhanced group prenatal care model that offers co-located social services provided by established community programs with independent funding streams targeting low-income families. The Glow! group prenatal care model pairs a trained facilitator with a licensed prenatal care practitioner from a practice site to provide billable prenatal care to the practice's own patients. Over the course of 8-10 sessions, 10-12 women (within a 6- week gestational age range) receive prenatal medical care, risk assessments, and social support, and gain knowledge and skills related to pregnancy, birth, and parenting.
Comprehensive Perinatal Services Program (CPSP) is a state-funded program for Medi-Cal eligible families to receive enhanced care and service coordination. Participants assigned to CPSP individual care may participate in the CPSP assessments with a Comprehensive Perinatal Health Worker at their prenatal care site, where individual prenatal care will be provided
Central Valley Health Policy Institute
Fresno, California, United States
UCSF
San Francisco, California, United States
Changes in Patient Health Questionnaire (PHQ-9) Score
Changes in depressive symptom severity from baseline to postpartum. Assessed using the Patient Health Questionnaire (PHQ-9), administered in-person at baseline and during telephone interview at three months postpartum. Total score ranges from 0-27 with higher scores indicating more severe depression.
Time frame: Collected from study enrollment to three months postpartum
Person-centered prenatal care
This outcome focuses on the extent to which the participants feels their prenatal care was person centered. The title of the measure is Person Centered Prenatal Care (primary). This measurement tool is a questionnaire that includes series of items that were developed in collaboration with community members to measure their experience of care. In addition to the overall score, the scale includes three subscales identified as important by community members: dignity and respect, communication and autonomy, and responsive and supportive care. The measures have been validated in several languages. The total scores range from 0-100 with higher scores indicating the receipt of more person centered care.
Time frame: Collected during third trimester
Preterm birth
Whether the participant had a baby born less than 37 weeks gestation, as noted in the participant's medical record.
Time frame: 0-12 weeks after delivery
Changes in anxiety symptom severity
Changes in anxiety symptom severity from baseline to postpartum. Assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale, administered in-person at baseline and during telephone interview at three months postpartum. The total scores range from 0-21 with higher scores indicating more severe anxiety.
Time frame: Collected from study enrollment to three months postpartum
Perceptions of respectful/disrespectful maternity care
Extent to which the participant feels that the maternity care they received was respectful. Assessed using the Mothers on Respect Index (MORi), administered during telephone interview or in-person at third trimester and three months postpartum. The total scores range from 14-84 with higher scores indicating a higher level of respect.
Time frame: Collected at three months postpartum
Satisfaction with prenatal care
Extent to which the participant feels satisfied with the prenatal care they received. Assessed using the Prenatal Care Satisfaction Scale, administered during telephone interview or in-person interview at third trimester and three months postpartum. The total scores range from 0-100 with higher scores indicating higher levels of satisfaction.
Time frame: Collected during third trimester and at three months postpartum
Gestational age at delivery
The gestation age at which the baby was born (number of weeks), as noted in the participant's medical record.
Time frame: 0-12 weeks after delivery
Person Centered Maternity Care as measured at 3 months postpartum.
Extent to which birthing person feels their prenatal and birthing experience was person centered, as measured by the Person-Centered Maternity Care scale. This measure focuses on the extent to which the participants feels their prenatal and maternity/birthing care was person centered. The title of the measure is Person Centered Maternity Care. This measurement tool is a questionnaire that includes series of items that were developed in collaboration with community members to measure their experience of care. In addition to the overall score, the scale includes three subscales identified as important by community members: dignity and respect, communication and autonomy, and responsive and supportive care. The measures have been validated in several languages. The total scores range from 0-100 with higher scores indicating the receipt of more person centered care.
Time frame: 3 months postpartum
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