The P3OPPY Project is one of five projects within the American Heart Association P3 EQUATE Network. The overarching goal of the P3 EQUATE American Heart Association Health Equity Research Network (HERN) is to promote equity in Maternal and Infant Health outcomes by identifying innovative and cost-effective strategies to enhance access to quality health information, care, and experiences during pregnancy, postnatal and postpartum/preconception periods, particularly for Black and under-served populations. Collectively, the investigators will collaborate with pregnant and postpartum individuals and their families, hospitals, and communities to discover ways to reduce racism and social problems that contribute to poor health outcomes.
Feasibility Study Aims 1. To assess the feasibility of the digital health (DHI) and community health worker (CHW) interventions by assessing participant acceptance and use of the intervention. 2. To assess study enrollment to determine appropriateness and usefulness of the inclusion and exclusion criteria to estimate enrollment duration in the planned trial. 3. To determine the number of prenatal visits and the incidence of some of the maternal and neonatal outcomes (ones with higher prevalence) or surrogate outcomes that will be targeted in the planned factorial design randomized controlled trial. (Data will be collected on all relevant maternal and neonatal outcomes. The randomized feasibility design will allow for effect size estimates of the intervention on the incidence of maternal and neonatal outcomes, which will aid in determining the appropriate target outcomes as well as power calculation of the more definitive trial.) The PᵌOPPY study is designed to support the American Heart Association's mission to improve maternal/infant health outcomes and address inequities in maternal/infant health care. The promise of digital health and community health worker engagement makes PᵌOPPY interventions potentially transformative, sustainable, and scalable for Non-Hispanic Black mothers and their infants from under-served communities in Alabama and beyond. The objective of this pilot study is to determine if it is feasible to randomize and implement digital health and community health worker interventions. Design Summary The investigators will challenge existing care paradigms by testing the effectiveness of integrating innovative platforms into the existing healthcare system, including existing digital health and community health worker programs from within the EQUATE consortium, to eliminate critical barriers to equitable healthcare access. After seeking input from a Community Advisory Board, these interventions will be refined and deployed for pilot testing. Individuals in Non-Hispanic Black communities at the highest risk of adverse pregnancy outcomes which were historically underrepresented in clinical research due to structural racism will be included. The investigative team employs experts across the community, maternal, and infant health continuum. For this pilot, 40 eligible participants will be randomized, 10 to usual care, 10 to DHI, 10 to CHW, and 10 to DHI + CHW
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
40
Health care information delivered via a link in a text message that is then opened in a secure browser.
Health care information delivered via CHW.
Health care information delivered via DHI plus CHW
University of Alabama at Birmingham
Birmingham, Alabama, United States
Participant Acceptance of Randomization Arm / Intervention
Participant acceptance is defined as a yes response to this question: "I would recommend the care I received to someone in a similar situation."
Time frame: 6 weeks postpartum
Participant Use of Digital Health and/or Community Health Worker Interventions
Use of the intervention for the digital health arm(s) is defined as the % of opened text messages. Use of the intervention for the community health worker arm(s) is defined as the % of planned sessions in which the participant engages with the community health worker.
Time frame: From randomization to 6 weeks postpartum
Outpatient Perinatal Care Visits
Number of perinatal care visits
Time frame: Randomization to study completion (up to 34 weeks)
Preterm Birth
Delivery of a neonate at less than 37 weeks
Time frame: At birth
Neonatal Birthweight
Weight of neonate at birth
Time frame: At birth
Cesarean Delivery
Occurrence of a cesarean birth
Time frame: At birth
Maternal Blood Transfusion
Transfusion of blood products
Time frame: At birth
Breastfeeding Intent
Participant's self-reported intent of whether or not to express breast milk upon admission to the delivery-associated hospitalization
Time frame: Upon admission to the delivery-associated hospitalization
Vaccination Rate
The number of mothers who received Tdap and infants who received the Hep B vaccine.
Time frame: Pregnancy through 6 weeks postpartum / 6 weeks of life
Maternal Postpartum Readmission
Admission of the mother to the hospital after discharge from the delivery-associated hospitalization
Time frame: From discharge from the delivery-associated hospitalization to 6 weeks postpartum
Neonatal Hospital Readmission
Answer to the question " How is your baby doing?"
Time frame: Birth to 6 weeks of life
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