Optimizing Birth Outcomes for Rural Women Providing Great Starts for Babies Building Hopeful Healthy Neighborhoods The Rural Health Innovation Collaborative A 14 member publicprivate notforprofit organization dedicated to community health and wellness interprofessional education and pra ID: 669511
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Slide1
Wabash Valley Healthy Moms and Babies Initiative
Optimizing Birth Outcomes for Rural Women
Providing Great Starts for Babies
Building Hopeful, Healthy Neighborhoods! Slide2
The Rural Health Innovation Collaborative
A 14 member public-private not-for-profit organization dedicated to community health and wellness, interprofessional education and practice, economic vitality.Slide3
National Leadership Academy for Public Health (NLAPH)
Sponsored by:
Public Health Institute
Centers for Disease Control and PreventionMission:
NLAPH
is an applied leadership training program that enables multi-sector jurisdictional teams to address public health problems within their communities through team-identified community health
improvement.
projects.
Goals:
Educate stakeholders about evidence-based policies
Drive the adoption of evidence-based practices in communities
Better align medicine and public health
Improve health outcomes in our nation through sustainable systems changeSlide4
Team Members: Wabash Valley Healthy Moms and Babies Slide5
Clay
Greene
Owen
ParkePutnam
Sullivan
Vermillion
Vigo
Wabash Valley Target CountiesSlide6
Key Activity 1: Learn from Communities
1. Engage
community stakeholders
to:Identify their priorities in light of state health data.
2. Promote:
Development of community-based prevention
and intervention
strategies.
Broad spectrum of community participation that leads to sustainability.Slide7
Impact to Date: Building Community Capacity for Better Birth Outcomes
Since March 2014:
I
nteracted with 98 community stakeholders within the identified counties.
Stakeholders identified priorities for community-based learning forums.
Follow-up sessions for 4 counties planned to facilitate solution strategies.Slide8
Topics of Interest in Wabash Valley Counties
Role of Fathers
Smoking Cessation
Safe EnvironmentSlide9
Key Activity 2: Implement Data Review Process to Produce Change
Goal:
Promote
regional data collection
regarding causes of fetal and infant death
Action:
Establish
regional
fetal
and infant mortality review board using perinatal periods of risk model
Outcomes: Strengthen state-regional connectionsPromote regional data collection to implement targeted prevention and intervention strategiesSlide10
Key Activity 3: Develop a Network of Community Maternal Health AdvocatesSlide11
What Causes Poor Birth Outcomes in your Neighborhood?
“I believe some of the things that contribute to poor birth outcomes are
stress
, poor eating habits, lack of support and knowledge, and sometimes habits that the pregnant mother can’t shake.”“
Lack of knowledge
and the fact that our culture does not emphasize asking for help”
“I believe the
lack of support, stress
and a lot to do with mothers just not living a healthy lifestyle and the
lack of knowledge
.”Slide12
ååå
Individual
Relationship
Community
Societal
Social – Ecological Model: A Framework for Prevention (CDC)Slide13
Why Focus on Fostering Supportive Relationships?
Toxic:
Strong, frequent, or prolonged activation of the body’s stress management system. Events that are chronic, uncontrollable, and experienced
without having access to the support of caring adults.
Tolerable:
Stress that occurs for brief periods, allowing the brain to recover.
Occurs in the presence of supportive adults,
which creates a safe environment for learning coping skills.
Positive:
Moderate, short-lived stress response, normal part of life. Learn to manage
with supportive relationships.Slide14
Linking Toxic Stress to Poor Birth
Outcomes
Allostatic
Load
Comprehensive
and cumulative risk across multiple physiological regulatory systems resulting from chronic exposure to life challenges or stressors that influence health outcomes across the life span (McEwen and Stellar, 1993)
.Slide15
Strategies to Reduce Stress
Identify sources of stress and strategies to deal with them
Sleep
Exercise (under direction)Good Nutrition: 5-6 small meals/day
Avoid smoking, alcohol and drugs
Support networkSlide16
Addressing Perinatal Mental Health in Low Income, Minority, and/or Rural Women
Major health concern in low income women-poses serious risks for a woman, her family, her infant.
FEW
studies or programs addressing minority, low income, or rural women during perinatal period.
Often these women do not seek help, until it is too late.
Easily accessible, low cost interventions
work
Support NetworksSlide17
Women's’ Networks are Powerful in Decision Making Processes
Peer supporters:
Connect health and social service providers with community
Cost effective way to improve health outcomes
Increase community acceptance
of health services
Peer Support Programs:
Improve
psychosocial variables associated with pregnancy outcomes in low-income
women
Improve
breastfeeding rates in low-income womenPromotes coping skills in first time mothers.
Anderson, AK, Damio, G, Young, S, Chapman, DJ, Perez-Escamilla, R (2005)Baffour, TD, Chonody, JM (2009) Canuso, R (2003)
Lapierre, J, Perreault, M, Goulet, C (1995) Slide18
MethodsSlide19
Connections Tiered ApproachSlide20
Community Health Advocacy Leaders
Received leadership training - EvaluLEAD
Provide leadership in project meetings and all elements of project
Moderated community learning forums
Form networks with national leaders in health disparities research and outreach.
Mentor peer support teams
Gail Ross
Kathy J. Trotter
Thelma SimsSlide21
Pregnancy Peer Support Program
Pregnant African American women (19-44 years of age) and peer supporters were recruited
Peer supporters completed a 6 hour training program
Pairs were matched based on personality assessment results
Pairs work together through infant’
s 3
rd
month
All participants received monthly gift cardSlide22
Pregnancy Peer Support Program Outcome Measures
Evaluate: change in anxiety, depression, and self efficacy of
BOTH
the pregnant woman and peer supporter.
Qualitative assessment of program via monthly structured interviews. Slide23
Recruitment Strategies
Peer Supporters
Work development programs
Local colleges/universities
Churches
Community events
Pregnant Women
WIC sites
2 local hospital-based OB/GYN practicesSlide24
Assessments
Quantitative
Big 5 Personality Test
Patient Health Questionnaire – 9 (PHQ-9)
State Trait Anxiety Inventory (STAI)
General Self Efficacy Scale (GSES)
Qualitative
Monthly structured interviews analyzed with NVivoSlide25
ResultsSlide26
Demographic Information
Peer Supporters:
17 women recruited and enrolled
Mean age 32.6
yrs
(range 21-60
yrs..)
15 women had ≥ 1 child; 2 had no children
14 were African American; 3 were Caucasian
Pregnant Women:
21 recruited and enrolledMean age 23.6 yrs. (range 19-31 yrs.)1 in 1st
trimester; 13 in 2nd trimester; 7 in 3rd trimester
Varied levels of support
40% in committed relationships; 40% “complicated” relationships; 20% unknown relationship status
Varied living situations
Living alone, with family and/or extended family, or with significant other’s familySlide27
Quantitative Results
Peer Supporters:
76%
completed
the program (n=13)
4 did not complete the program
1 left program (lost contact)
2 pregnant women left program
1 pregnant woman requested different peer supporter
Pregnant Women:
71
% completed
the program (n=15)
6 women did not complete the program
3 left the program (lost contact)
1 due to infant death
2 completed the program, but failed to complete exit assessments (lost contact)
16 total pairs, average length of relationship = 6
mos.
(range 3-8
mos.)Slide28
Birth Outcomes
1 set of twins born at 25 weeks gestation (1 passed away at 3 months)
1 late preterm infant
1 low birth weight baby1 infant death at delivery due to placental abruptionSlide29
Big 5 Personality Test Results
*Slide30
PHQ-9 Scores
Entry ExitSlide31
PHQ-9 Peer SupportersSlide32
PHQ-9 Pregnant WomenSlide33
STAI Scores
State Anxiety Trait AnxietySlide34
STAI Trait Scores - Peer SupportersSlide35
STAI Trait Scores - Pregnant WomenSlide36
GSES Scores
Entry ExitSlide37
GSES – Peer SupportersSlide38
GSES Scores – Pregnant WomenSlide39
Qualitative Results
1. How often did you “meet?”
Weekly
2. How did you communicate with each other?
Text
Phone
3. What kinds of things did you talk about?
Baby/pregnancy
Baby’s father - in/out of the picture, how to deal with lack of help
Relationships – with family and baby’s father
“Issues
” (personal, financial, and family)Slide40
Qualitative Results
4a. What kinds of stressors did you encounter this past month?
Concern about baby’s health and growth
Disappearing and reappearing father
Work
School
None
4b. How has your peer support relationship helped?
Gave peer supporters and pregnant women someone to talk to
Helped take their mind of their own troubles and help someone
else
5. What do you hope to gain from your peer support relationship during this upcoming month? Do you have any expectations?Continued support of each other and friendshipNo expectationsCloser relationshipSlide41
Qualitative Results
6. Do you have any ideas/suggestions for activities or topics to discuss during our next Connections family meeting?
Breastfeeding
Baby preparedness
How to deal with the fathers when they are not supportive
Healthy relationships
Social gatherings
7. What can we do to help you optimize your peer support relationship?
Nothing
Good relationshipSlide42
Monthly Family Meetings
Key
Objectives
Socialization
Celebrating
Baby Showers
Professional Development
Breastfeeding
Financial management
Nutrition Moment
Career readiness
The role of menSlide43
What We Learned
Peer supporters provided the 3 elements of social support (
Antonucci, 1985; House & Kahn, 1985; Kahn & Antonucci,
1980)EmotionalInstrumental
Instructional
The importance of community leaders
Challenging work – need of a social worker to assist
The power of the social determinants of health – the joy of
fostering relationshipsSlide44
University of Nebraska Medical Center
Thank you!
Acknowledgements:
Funding: Nebraska Department of Health and Human Services, The Learning Community of Douglas and Sarpy Counties, Nebraska March of Dimes
,
Omaha Home for Boys,
and the generous donations of private philanthropists.
Staff: Kathleen Burke, PhD, Kellee Hanigan, DPT, Dennis Molfese, PhD and lab staff, Susan Landry, PhD and lab staff, Lisa St. Clair, PhD, Jack Turman, III and Fran Higgins for photographic and videographic work.