The COVID-19 pandemic has transformed healthcare delivery; arguably, the fields of obstetrics and pediatrics have experienced some of the greatest changes as they have transitioned away from their role as a medical home and into more of an urgent care model of care. Baby2Home is a digital health intervention designed to bridge the resultant gaps in obstetrics and pediatrics healthcare services for new families over the first year of life. This randomized controlled trial will evaluate whether, compared to usual care, Baby2Home 1) improves maternal, paternal, and infant health service utilization outcomes over the first year postpartum, 2) improves maternal and paternal patient reported outcomes, and 3) reduces racial/ethnic and income-based disparities in preventive health services utilization and parental patient reported outcomes.
The transition to new parenthood is marked by dramatic changes in social roles and responsibilities. To support new parents, obstetric and pediatric healthcare surrounding this transition is designed with a supportive focus to facilitate new parents' navigation of the attendant life changes. The COVID-19 pandemic has altered healthcare delivery in ways that have limited these supportive obstetrics and pediatric services provided at the beginning of new parenthood. Consequently, aspects of preventative healthcare, such as monitoring for symptoms of postpartum depression, discussing optimal birth control options, educating parents on recommended adult and pediatric vaccinations, and providing anticipatory guidance on infant wellness, are less robust. In addition, without professional guidance and support, outcomes of foundational importance to new parents, such as perceived stress, depressive and anxiety symptoms, or parenting and breast-feeding self-efficacy, are worse. Moreover, the COVID-19 pandemic has underscored the impact of the social determinants of health on new family wellness, with racial/ethnic minority and low-income families being differentially impacted by COVID-19 pandemic driven healthcare delivery changes. Recognizing the potential for longitudinal changes in healthcare delivery engendered by the COVID-19 pandemic, a scalable, patient-centered, equity-focused intervention designed to bridge gaps in healthcare services around the transition to new parenthood is needed. "Bridging gaps in healthcare delivery to COVID-19 for parent and infants from birth through the first year of life" aims to evaluate Baby2Home (B2H) a patient-informed digital healthcare intervention that s is specifically responsive to the COVID-19 pandemic's impact on new families, with a focus on health equity for racial/ethnic minority and low-income families. B2H builds upon previous digital health successes while incorporating the evidence-based collaborative care model for mental health support. B2H is designed to mitigate the adverse effects of healthcare delivery changes in response to the COVID-19 pandemic and to improve health for mothers, fathers, and infants over the first year of life. Developed from feedback given by new parents who delivered during the COVID-19 pandemic, B2H provides 1) parental education about their own physical and mental health, 2) infant wellness resources and tracking of recommended healthcare services, 3) parental mental health screening and support, and 4) systematic case review to optimize the health of new families. The investigators will test the efficacy of B2H via a randomized control trial. In total, 640 diverse families will be randomly to either usual care or B2H intervention arm to evaluate whether, compared to usual care, B2H health services utilization and patient reported outcomes of foundational important to new families. addition, the investigators will evaluate the impact of B2H on racial/ethnic and income-based disparities observed in both services utilization and patient reported outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
642
Baby2Home is a digital health intervention designed to bridge the resultant gaps in obstetrics and pediatrics healthcare services for new families over the first year of life.
Northwestern Medicine Prentice Women's Hospital
Chicago, Illinois, United States
Women and Infant's Hospital
Providence, Rhode Island, United States
Completion of preventive health services utilization for all family members (birthing, non-birthing, and infant)
The primary outcome defined as positive if all of the items below are met for all family members: 1. optimal maternal preventive health services utilization over the 1st year postpartum (including attendance at the comprehensive postpartum visit, receives chosen contraceptive method, and undergoes postpartum depression screening) 2. optimal paternal/co-parental preventive health services utilization over the 1st year postpartum (including receiving recommended vaccinations for new parents, if desires a male-driven contraceptive option, receives chosen method, and undergoes screening for depression) 3. optimal infant preventive health services utilization over the 1st year postpartum (including attending all AAP recommended wellness visits, receiving all AAP recommended vaccines, and receiving breast milk for 6 months of life)
Time frame: Baseline through 1 year postpartum
Number of participants who attend comprehensive postpartum visit (birthing parent)
Subject returns for a comprehensive medical care at least once between 4 and 12 weeks postpartum. This visit should include documented elements of physical health, mood, mode of infant feeding, contraception, preventive health, and any comorbidities.
Time frame: At least once between 4 and 12 weeks postpartum
Completion of postpartum depression screening (birthing parent)
Subject completes a validated screen for postpartum depression and, if the screen is positive, receives a recommendation for treatment. To assess depressive symptoms, birthing will take the 9-item Patient Health Questionnaire (PHQ). This is scored on a Likert-type scale from 0 - 3 (Not at all to Nearly everyday). A lower score reflects minimal depression and a higher score reflects severe depression.
Time frame: Through study completion, up to 12 months
Number of participants who received contraception (birthing and non-birthing parent)
If a subject desires a contraceptive method, they receives chosen method. Receipt of contraception can be an actual insertion of device (implant or IUD), receipt of injection, receipt of sterilization (BTL or vasectomy, if vasectomy is confirmed to have been performed), or prescription for a combined hormonal contraceptive method.
Time frame: Through study completion, up to 12 months
Number of participants who received the recommended vaccinations (non-birthing parent)
Subject receives influenza and TDaP vaccines before 12 months postpartum.
Time frame: Through study completion, up to 12 months
Completion of postnatal depression screening for non-birthing parent
Subject completes a validated screen for depression. To assess depressive symptoms, non-birthing parents will take the 9-item Patient Health Questionnaire (PHQ). This is scored on a Likert-type scale from 0 - 3 (Not at all to Nearly everyday). A lower score reflects minimal depression and a higher score reflects severe depression.
Time frame: Through study completion, up to 12 months
Number of participants who attended well-child visits for the infant
Subject attends all AAP recommended wellness visits. Attendance at each visit will be derived from both patient-report (via B2H) and through ROIs from the pediatrician offices. Preference will be given to the ROIs, but if this not available, patient-report will be used as equal. If these data points are conflicting, patient-report will supersede the medical record.
Time frame: Through study completion, up to 12 months
Number of participants who received the recommended vaccinations for infant
Subject receives all AAP recommended vaccinations. This information will be ascertained from the ROIs from the pediatrician offices. Recognizing various vaccine schedules, this will be determined as a binary variable at 12 months postpartum (and the % of vaccines received).
Time frame: Through study completion, up to 12 months
Continued breastfeeding for infants until 6 months
This outcome will be patient-reported. The investigators will evaluate this outcome as positive if breastmilk is a source of nutrition until 6 months. The primary analysis will be of all subjects who were eligible for breastfeeding (i.e., excluding those unable to breastfeed due to a medical complication). Investigators will perform secondary analyses in which individuals who do not desire breastfeeding and did not initiate breastfeeding will not be considered in this component of outcomes.
Time frame: Through study completion, up to 6 months
Duration of breastfeeding (birthing parent)
This outcome will be patient-reported. The investigators will also evaluate as an ordinal outcome of total duration (months) of any breastfeeding and total duration (months) of exclusive breastfeeding. The primary analysis will be of all subjects who were eligible for breastfeeding (i.e., excluding those unable to breastfeed), but the investigators will perform secondary analyses in which individuals who do not desire breastfeeding and did not initiate breastfeeding will not be considered in this component of outcomes.
Time frame: Through study completion, up to 6 months
Patient reported outcomes: stress symptoms (for birthing and non-birthing parent)
To assess stress, birthing and non-birthing parents will take the 10-item Perceived Stress Scale (PSS). This is scored on a Likert-type scale from 0 - 4 (Never to Very often). Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: depressive symptoms (for birthing and non-birthing parent)
To assess depressive symptoms, birthing and non-birthing parents will take the 9-item Patient Health Questionnaire (PHQ). This is scored on a Likert-type scale from 0 - 3 (Not at all to Nearly everyday). A lower score reflects minimal depression and a higher score reflects severe depression.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: anxiety symptoms (for birthing and non-birthing parent)
To assess anxiety, birthing and non-birthing parents will take the 7-item Generalized Anxiety Disorder Scale. This is scored on a Likert-type scale from 0 - 3 (Not at all to Nearly everyday). A lower score reflects minimal anxiety and a higher score reflects severe anxiety.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: global health status (for birthing and non-birthing parent)
To assess health status, birthing and non-birthing parents will take the 10-item PROMIS Global Health Scale. This is scored on a Likert-type scale from 5 - 1 (Excellent to Poor). A higher score indicates better health status.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: relationship assessment (for birthing and non-birthing parent)
To assess relationship status, birthing and non-birthing parents will take the 14-item Revised Dyadic Adjustment Scale (RDAS). This is scored on a Likert-type scale from 0 - 5 (Everyday to Never). Scores on the RDAS range from 0 to 69 with higher scores indicating greater relationship satisfaction and lower scores indicating greater relationship distress. The cut-off score for the RDAS is 48 such that scores of 48 and above indicate non-distress and scores of 47 and below indicate marital/relationship distress.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: self-efficacy (for birthing and non-birthing parent)
To assess self-efficacy, birthing and non-birthing parents will take the 10-item PROMIS Self-Efficacy Scale. This is scored on a Likert-type scale from 1 - 5 (I am not at all confident to I am very confident). A higher score indicates a higher sense of general self-efficacy.
Time frame: Month 1, 2, 4, 6, and 12
Patient reported outcomes: parenting self-efficacy (for birthing and non-birthing parent)
To assess parenting self-efficacy, birthing and non-birthing parents will take the 17-item Parenting Sense of Competence Scale. This is scored on a Likert-type scale from 1 - 6 (Strongly Disagree to Strongly Agree). A higher score indicates a higher parenting sense of competency.
Time frame: Month 12
Patient reported outcomes: breastfeeding self-efficacy (for birthing parent)
To assess breastfeeding self-efficacy, birthing parents will take the 12-item Breastfeeding Self-Efficacy scale. This is scored on a Likert-type scale from 1 - 7 (Strongly Disagree to Strongly Agree). A higher score indicates a better/more positive outcome towards breastfeeding.
Time frame: Month 1, 2, 4, 6, and 12
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