The purpose of this study is to compare the effectiveness of H42-HV integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention (difference between pre-pregnancy weight and weight at 6 months postpartum) among pregnant and postpartum participants. The overall goal is to improve long-term cardiometabolic health.
There are four components of the H42-HV intervention: 1) Health coaching calls; 2) H42 web-based app for learning activities and goal setting functions; 3) Tracking of health behaviors (diet, exercise), and 4) Self-weighing (weekly). The overarching behavioral goals of the intervention are for participants to have lower postpartum weight retention at 6 months after delivery. Weight and behavioral goals will be promoted through the COACH Plan, a behavioral model guiding coaching calls, behavioral tracking targets and learning activities. Coaches will refer to home visitors for additional support and community resources, based on an established protocol. * Telephone health coaching calls by trained health coaches. Calls start at enrollment, between 20-33-weeks gestation through 6 months postpartum. Although coaching calls will occur by phone or Zoom (\~20 mins), when possible, some coach contact could occur at the time of home visits in person. * Online interactive learning activities. Literacy adaptation ensured Learning Activities are at \<5th grade reading level. All activities are translated into Spanish and culturally adapted to create a parallel program. Online learning activities contain embedded images (people and settings) that reflect the diversity of the investigators' target population, examples of activities that are readily available in the community and maximize the use of white space, large text and simple graphics to enhance readability and accessibility of the educational content. The investigators enhanced the platform to enable an interactive goal-setting functionality for participants to set health goals paced with participants' Learning Activities and calls. The online program is maintained and monitored by the study's health coach managers. * Health behavior tracking (diet and exercise). Participants will receive specific skill-building on how to track diet and exercise behaviors via mainstream mobile app or paper/pencil, using procedures from the investigators' current trial. Coaches will be able to discuss tracking data with participants. Mainstream tracking apps are available in both Spanish and English. * Weekly self-weighing. Participants will be asked to weigh themselves weekly at home using the participants' study scale.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
360
The H42-HV intervention includes health coaching calls, H42 web based app, mobile phone-based tracking.
A brief video on maternal warning signs that is available in English or Spanish.
Johns Hopkins School of Nursing
Baltimore, Maryland, United States
RECRUITINGChange in postpartum weight (retention)
Difference between pre-pregnancy weight and weight at 6 months postpartum. Pre-pregnancy weight (baseline) will be self-reported and then confirmed by prenatal clinic medical records. 6 month postpartum weight will be obtained via BodyTrace study scales provided to all participants.
Time frame: Baseline and 6 months postpartum
Change in gestational weight (gain)
Difference between pre-pregnancy weight and delivery weight. Pre-pregnancy weight will be self-reported and then confirmed by prenatal clinic records. Delivery weight will be obtained via BodyTrace study scales provided to each participant.
Time frame: Baseline and immediately before delivery
Change in maternal diet as assessed by the Dietary Screener Questionnaire (DSQ)
Dietary intake will be assessed using the NHANES 2009-10 Dietary Screener Questionnaire (DSQ) Eating Habits Questionnaire (28-items). Scoring equations exist to estimate daily intake of fruits/vegetables, dairy, added sugars, whole grains, and calcium.
Time frame: Baseline, 37 weeks gestation, 2 months postpartum, 4 months postpartum, 6 months postpartum
Change in maternal physical activity as assessed by the International Physical Activity Questionnaire (IPAQ)
The Short Form International Physical Activity Questionnaire contains 9 items to collect data on health-related physical activity in the past seven days. Physical activity is categorized as high (at least one hour of moderate intensity exercise daily), moderate (approximately 30 minutes of moderate intensity exercise most days), or low (not meeting the criteria of high or moderate exercise).
Time frame: Baseline, 37 weeks gestation, 2 months postpartum, 4 months postpartum, 6 months postpartum
Maternal smoking habits as assessed by the Center for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System (CDC PRAMS)
A four-item portion of the PRAMS survey will be utilized to determine cigarette use before and during pregnancy.
Time frame: Baseline
Change in breastfeeding Practice as assessed by the Center for Disease Control and Prevention Infant Feeding Practices Survey (CDC IFPS)
A 4-item portion of the CDC IFPS will be used at 2,4, and 6 months postpartum to assess current breastfeeding practice.
Time frame: 2 months postpartum, 4 months postpartum, 6 months postpartum
Breastfeeding Intention as assessed by the Center for Disease Control and Prevention Infant Feeding Practices Survey (CDC IFPS)
A two-item portion of the CDC IFPS will be used to assess breastfeeding intention.
Time frame: 37 weeks gestation
Change in maternal depression as assessed by the Edinburgh Postpartum Depression scale
The Edinburgh Postpartum Depression scale is a 10-item measure assessing changes in mood over the past seven days. The last question related to suicidal ideation has been removed. Mothers who score above 13 are likely to be suffering from a depressive illness of varying severity.
Time frame: Baseline, 37 weeks gestation, 2 months postpartum, 4 months postpartum, 6 months postpartum
Change in maternal sleep habits as assessed by the Pittsburgh Sleep Quality Index (PSQI)
The PSQI is a 19-item questionnaire assessing sleep habits in the past seven days. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score (0-21) and higher scores indicate worse sleep quality.
Time frame: Baseline, 2 months postpartum, 4 months postpartum, 6 months postpartum
Change in maternal social support as assessed by the Functional Social Support Questionnaire (FSSQ)
The FSSQ is an 8-item measure that evaluates confidant support and affective support. Responses are scored 1-5 and an average is calculated based on the response from all eight items. A higher score indicates greater perceived social support.
Time frame: Baseline, 36-38 weeks prenatal, 2 months postpartum, 4 months postpartum, 6 months postpartum
Maternal healthcare utilization as assessed by Medicaid data extraction
Postpartum OBGYN visit and primary care provider visit by six months.
Time frame: Up to 6 months after delivery
Infant healthcare utilization as assessed by Medicaid data extraction
Well-child visit appointments through six months of life.
Time frame: Up to 6 months after delivery
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