Disparities, Infants, Pregnancy
Conditions
Keywords
Pregnancy outcomes, Health inequities
Brief summary
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.
Detailed description
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
Interventions
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
Sponsors
Study design
Intervention model description
Study is a pilot randomized trial (n=40) randomizing eligible participants to usual care (n=10), or usual care plus a digital health intervention (n=10), or usual care plus a community health worker intervention (n=10), or usual care plus both a digital health intervention and a community health worker intervention.
Eligibility
Inclusion criteria
* Self Identifies as Non-Hispanic Black * Between 16-49 years old * Pregnant individuals between 8⁰ - 22⁶ weeks gestational age * Live singleton or dichorionic twin gestation * Dating sonogram at \<23 weeks gestation * Area Deprivation Index (ADI) National 4th or 5th Quintile * Planning to deliver at UAB Hospital * Speaks and writes in English * No indication for delivery at the time of enrollment
Exclusion criteria
* Declines randomization * Speaks or writes in languages other than English * Currently incarcerated * Fetal demise diagnosed prior to enrollment * Known major structural chromosomal abnormalities prior to enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participant Acceptance of Randomization Arm / Intervention | 6 weeks postpartum | Participant acceptance is defined as a yes response to this question: I would recommend the care I received to someone in a similar situation. |
| Participant Use of Digital Health and/or Community Health Worker Interventions | From randomization to 6 weeks postpartum | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neonatal Birthweight | At birth | Weight of neonate at birth |
| Cesarean Delivery | At birth | Occurrence of a cesarean birth |
| Maternal Blood Transfusion | At birth | Transfusion of blood products |
| Outpatient Perinatal Care Visits | Randomization to study completion (up to 34 weeks) | Number of perinatal care visits |
| Vaccination Rate | Pregnancy through 6 weeks postpartum / 6 weeks of life | The number of mothers who received Tdap and infants who received the Hep B vaccine. |
| Maternal Postpartum Readmission | From discharge from the delivery-associated hospitalization to 6 weeks postpartum | Admission of the mother to the hospital after discharge from the delivery-associated hospitalization |
| Neonatal Hospital Readmission | Birth to 6 weeks of life | Answer to the question How is your baby doing? |
| Breastfeeding Intent | Upon admission to the delivery-associated hospitalization | Participant's self-reported intent of whether or not to express breast milk upon admission to the delivery-associated hospitalization |
| Preterm Birth | At birth | Delivery of a neonate at less than 37 weeks |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Digital Health Intervention (DHI) This group will receive routine prenatal care services. Additionally, those randomized to this arm will receive a DHI intervention. A modified DHI will be utilized that was developed by Memora Health in conjunction with EQUATE partners at UPenn and feedback from the POPPY Study Team and Community Advisory Board. All content is designed for 7th grade Flesch-Kincaid level or lower. | 9 |
| Community Health Worker (CHW) Individuals randomized to this group will receive routine prenatal care services. Additionally, they will receive a CHW intervention. The CHW intervention will be adapted from an ongoing CHW program in Jefferson County, AL called From Day One (FDO), a comprehensive patient-centered program designed to educate and provide non-clinical, psychosocial, emotional support to expectant mothers from the 1st trimester of pregnancy through their child's first year of life. The intervention has been modified by the POPPY Study Team and Community Advisory Board. | 10 |
| DHI Plus CHW This group will receive routine prenatal care services. Additionally, this group will receive both DHI and CHW interventions. | 11 |
| Usual Care This group will receive routine prenatal care services. | 10 |
| Total | 40 |
Baseline characteristics
| Characteristic | Total | Usual Care | DHI Plus CHW | Digital Health Intervention (DHI) | Community Health Worker (CHW) |
|---|---|---|---|---|---|
| Age, Continuous | 29.1 years | 24.9 years | 29.1 years | 30.8 years | 29.5 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 40 Participants | 10 Participants | 11 Participants | 9 Participants | 10 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 40 Participants | 10 Participants | 11 Participants | 9 Participants | 10 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 40 Participants | 10 Participants | 11 Participants | 9 Participants | 10 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 9 | 0 / 10 | 0 / 11 | 0 / 10 |
| other Total, other adverse events | 0 / 9 | 0 / 10 | 0 / 11 | 0 / 10 |
| serious Total, serious adverse events | 0 / 9 | 0 / 10 | 0 / 11 | 0 / 10 |
Outcome results
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
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Participant Acceptance of Randomization Arm / Intervention | Yes | 8 Participants |
| Digital Health Intervention (DHI) | Participant Acceptance of Randomization Arm / Intervention | No | 0 Participants |
| Digital Health Intervention (DHI) | Participant Acceptance of Randomization Arm / Intervention | Missing or Unknown | 1 Participants |
| Community Health Worker (CHW) | Participant Acceptance of Randomization Arm / Intervention | Yes | 8 Participants |
| Community Health Worker (CHW) | Participant Acceptance of Randomization Arm / Intervention | No | 0 Participants |
| Community Health Worker (CHW) | Participant Acceptance of Randomization Arm / Intervention | Missing or Unknown | 2 Participants |
| DHI Plus CHW | Participant Acceptance of Randomization Arm / Intervention | Missing or Unknown | 1 Participants |
| DHI Plus CHW | Participant Acceptance of Randomization Arm / Intervention | Yes | 10 Participants |
| DHI Plus CHW | Participant Acceptance of Randomization Arm / Intervention | No | 0 Participants |
| Usual Care | Participant Acceptance of Randomization Arm / Intervention | Yes | 7 Participants |
| Usual Care | Participant Acceptance of Randomization Arm / Intervention | No | 1 Participants |
| Usual Care | Participant Acceptance of Randomization Arm / Intervention | Missing or Unknown | 2 Participants |
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
Population: We did not collect data for this outcome as planned because the University legal department would not allow texting in the manner initially planned.
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
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Breastfeeding Intent | Do not know yet | 1 Participants |
| Digital Health Intervention (DHI) | Breastfeeding Intent | Formula feed only | 3 Participants |
| Digital Health Intervention (DHI) | Breastfeeding Intent | Missing | 0 Participants |
| Digital Health Intervention (DHI) | Breastfeeding Intent | Both breast and formula feed | 3 Participants |
| Digital Health Intervention (DHI) | Breastfeeding Intent | Breastfeed only | 2 Participants |
| Community Health Worker (CHW) | Breastfeeding Intent | Both breast and formula feed | 1 Participants |
| Community Health Worker (CHW) | Breastfeeding Intent | Do not know yet | 3 Participants |
| Community Health Worker (CHW) | Breastfeeding Intent | Missing | 2 Participants |
| Community Health Worker (CHW) | Breastfeeding Intent | Formula feed only | 3 Participants |
| Community Health Worker (CHW) | Breastfeeding Intent | Breastfeed only | 1 Participants |
| DHI Plus CHW | Breastfeeding Intent | Both breast and formula feed | 1 Participants |
| DHI Plus CHW | Breastfeeding Intent | Breastfeed only | 1 Participants |
| DHI Plus CHW | Breastfeeding Intent | Formula feed only | 3 Participants |
| DHI Plus CHW | Breastfeeding Intent | Do not know yet | 2 Participants |
| DHI Plus CHW | Breastfeeding Intent | Missing | 4 Participants |
| Usual Care | Breastfeeding Intent | Do not know yet | 1 Participants |
| Usual Care | Breastfeeding Intent | Formula feed only | 1 Participants |
| Usual Care | Breastfeeding Intent | Breastfeed only | 2 Participants |
| Usual Care | Breastfeeding Intent | Both breast and formula feed | 6 Participants |
| Usual Care | Breastfeeding Intent | Missing | 0 Participants |
Cesarean Delivery
Occurrence of a cesarean birth
Time frame: At birth
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Cesarean Delivery | Cesarean | 7 Participants |
| Digital Health Intervention (DHI) | Cesarean Delivery | Missing | 0 Participants |
| Digital Health Intervention (DHI) | Cesarean Delivery | Vaginal | 2 Participants |
| Community Health Worker (CHW) | Cesarean Delivery | Cesarean | 5 Participants |
| Community Health Worker (CHW) | Cesarean Delivery | Missing | 2 Participants |
| Community Health Worker (CHW) | Cesarean Delivery | Vaginal | 3 Participants |
| DHI Plus CHW | Cesarean Delivery | Vaginal | 8 Participants |
| DHI Plus CHW | Cesarean Delivery | Cesarean | 3 Participants |
| DHI Plus CHW | Cesarean Delivery | Missing | 0 Participants |
| Usual Care | Cesarean Delivery | Cesarean | 3 Participants |
| Usual Care | Cesarean Delivery | Missing | 0 Participants |
| Usual Care | Cesarean Delivery | Vaginal | 7 Participants |
Maternal Blood Transfusion
Transfusion of blood products
Time frame: At birth
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Maternal Blood Transfusion | Missing | 0 Participants |
| Digital Health Intervention (DHI) | Maternal Blood Transfusion | No | 8 Participants |
| Digital Health Intervention (DHI) | Maternal Blood Transfusion | Yes | 1 Participants |
| Community Health Worker (CHW) | Maternal Blood Transfusion | No | 8 Participants |
| Community Health Worker (CHW) | Maternal Blood Transfusion | Yes | 0 Participants |
| Community Health Worker (CHW) | Maternal Blood Transfusion | Missing | 2 Participants |
| DHI Plus CHW | Maternal Blood Transfusion | Yes | 1 Participants |
| DHI Plus CHW | Maternal Blood Transfusion | No | 10 Participants |
| DHI Plus CHW | Maternal Blood Transfusion | Missing | 0 Participants |
| Usual Care | Maternal Blood Transfusion | No | 8 Participants |
| Usual Care | Maternal Blood Transfusion | Missing | 0 Participants |
| Usual Care | Maternal Blood Transfusion | Yes | 2 Participants |
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
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Maternal Postpartum Readmission | No Readmission | 9 Participants |
| Digital Health Intervention (DHI) | Maternal Postpartum Readmission | Readmission | 0 Participants |
| Community Health Worker (CHW) | Maternal Postpartum Readmission | No Readmission | 10 Participants |
| Community Health Worker (CHW) | Maternal Postpartum Readmission | Readmission | 0 Participants |
| DHI Plus CHW | Maternal Postpartum Readmission | Readmission | 1 Participants |
| DHI Plus CHW | Maternal Postpartum Readmission | No Readmission | 10 Participants |
| Usual Care | Maternal Postpartum Readmission | Readmission | 2 Participants |
| Usual Care | Maternal Postpartum Readmission | No Readmission | 8 Participants |
Neonatal Birthweight
Weight of neonate at birth
Time frame: At birth
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Digital Health Intervention (DHI) | Neonatal Birthweight | 3160.0 grams |
| Community Health Worker (CHW) | Neonatal Birthweight | 3150.0 grams |
| DHI Plus CHW | Neonatal Birthweight | 2815.0 grams |
| Usual Care | Neonatal Birthweight | 2920.0 grams |
Neonatal Hospital Readmission
Answer to the question How is your baby doing?
Time frame: Birth to 6 weeks of life
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Neonatal Hospital Readmission | Missing | 1 Participants |
| Digital Health Intervention (DHI) | Neonatal Hospital Readmission | Some Illness (Hospitalization, Clinic, or ER) | 0 Participants |
| Digital Health Intervention (DHI) | Neonatal Hospital Readmission | Healthy | 8 Participants |
| Digital Health Intervention (DHI) | Neonatal Hospital Readmission | Baby Died | 0 Participants |
| Community Health Worker (CHW) | Neonatal Hospital Readmission | Some Illness (Hospitalization, Clinic, or ER) | 0 Participants |
| Community Health Worker (CHW) | Neonatal Hospital Readmission | Baby Died | 0 Participants |
| Community Health Worker (CHW) | Neonatal Hospital Readmission | Healthy | 8 Participants |
| Community Health Worker (CHW) | Neonatal Hospital Readmission | Missing | 2 Participants |
| DHI Plus CHW | Neonatal Hospital Readmission | Healthy | 7 Participants |
| DHI Plus CHW | Neonatal Hospital Readmission | Some Illness (Hospitalization, Clinic, or ER) | 0 Participants |
| DHI Plus CHW | Neonatal Hospital Readmission | Baby Died | 4 Participants |
| DHI Plus CHW | Neonatal Hospital Readmission | Missing | 0 Participants |
| Usual Care | Neonatal Hospital Readmission | Some Illness (Hospitalization, Clinic, or ER) | 1 Participants |
| Usual Care | Neonatal Hospital Readmission | Healthy | 7 Participants |
| Usual Care | Neonatal Hospital Readmission | Missing | 1 Participants |
| Usual Care | Neonatal Hospital Readmission | Baby Died | 1 Participants |
Outpatient Perinatal Care Visits
Number of perinatal care visits
Time frame: Randomization to study completion (up to 34 weeks)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Digital Health Intervention (DHI) | Outpatient Perinatal Care Visits | 13 Visits |
| Community Health Worker (CHW) | Outpatient Perinatal Care Visits | 9.5 Visits |
| DHI Plus CHW | Outpatient Perinatal Care Visits | 9 Visits |
| Usual Care | Outpatient Perinatal Care Visits | 12 Visits |
Preterm Birth
Delivery of a neonate at less than 37 weeks
Time frame: At birth
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Digital Health Intervention (DHI) | Preterm Birth | Yes | 2 Participants |
| Digital Health Intervention (DHI) | Preterm Birth | Missing | 0 Participants |
| Digital Health Intervention (DHI) | Preterm Birth | No | 7 Participants |
| Community Health Worker (CHW) | Preterm Birth | Yes | 1 Participants |
| Community Health Worker (CHW) | Preterm Birth | Missing | 2 Participants |
| Community Health Worker (CHW) | Preterm Birth | No | 7 Participants |
| DHI Plus CHW | Preterm Birth | No | 7 Participants |
| DHI Plus CHW | Preterm Birth | Yes | 4 Participants |
| DHI Plus CHW | Preterm Birth | Missing | 0 Participants |
| Usual Care | Preterm Birth | Yes | 3 Participants |
| Usual Care | Preterm Birth | Missing | 0 Participants |
| Usual Care | Preterm Birth | No | 7 Participants |
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
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Digital Health Intervention (DHI) | Vaccination Rate | Newborn Hep. B | Accepted | 6 Participants |
| Digital Health Intervention (DHI) | Vaccination Rate | Maternal TDAP | Accepted | 7 Participants |
| Digital Health Intervention (DHI) | Vaccination Rate | Maternal TDAP | Newborn Death | 0 Participants |
| Digital Health Intervention (DHI) | Vaccination Rate | Maternal TDAP | Did not receive | 2 Participants |
| Digital Health Intervention (DHI) | Vaccination Rate | Newborn Hep. B | Did not receive | 3 Participants |
| Digital Health Intervention (DHI) | Vaccination Rate | Newborn Hep. B | Newborn Death | 0 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Newborn Hep. B | Did not receive | 3 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Newborn Hep. B | Newborn Death | 1 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Maternal TDAP | Did not receive | 6 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Maternal TDAP | Newborn Death | 0 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Maternal TDAP | Accepted | 4 Participants |
| Community Health Worker (CHW) | Vaccination Rate | Newborn Hep. B | Accepted | 6 Participants |
| DHI Plus CHW | Vaccination Rate | Maternal TDAP | Did not receive | 6 Participants |
| DHI Plus CHW | Vaccination Rate | Newborn Hep. B | Did not receive | 5 Participants |
| DHI Plus CHW | Vaccination Rate | Newborn Hep. B | Accepted | 6 Participants |
| DHI Plus CHW | Vaccination Rate | Maternal TDAP | Accepted | 5 Participants |
| DHI Plus CHW | Vaccination Rate | Maternal TDAP | Newborn Death | 0 Participants |
| DHI Plus CHW | Vaccination Rate | Newborn Hep. B | Newborn Death | 0 Participants |
| Usual Care | Vaccination Rate | Newborn Hep. B | Newborn Death | 0 Participants |
| Usual Care | Vaccination Rate | Maternal TDAP | Did not receive | 5 Participants |
| Usual Care | Vaccination Rate | Maternal TDAP | Newborn Death | 0 Participants |
| Usual Care | Vaccination Rate | Newborn Hep. B | Accepted | 7 Participants |
| Usual Care | Vaccination Rate | Newborn Hep. B | Did not receive | 3 Participants |
| Usual Care | Vaccination Rate | Maternal TDAP | Accepted | 5 Participants |