Lessons Learned from Maternal Health Community Health Club Implementation
Explore lessons learned from implementing a Maternal Health Community Health Club aimed at reducing maternal mortality, highlighting definitions, statistics, contributing factors, and the impact on communities. Insights from the Joint Biennial Report of 2019 cases emphasize preventable factors and disparities faced by Non-Hispanic Black women.
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Lessons Learned: Implementing a Maternal Health Community Health Club Autumn Chidester; Olivia Hoffstadt, MD; Caitlin Stanley; Melanie Stone, MPH, MEd; Jason Rosenfeld, MPH, DrPH
Table of contents 01 02 Introduction Initial project 0 4 03 Lessons Learned Conclusions
01 Introduction
Maternal Mortality Definitions Pregnancy-associated death: The death of a woman while pregnant or within 1 year of the end of pregnancy, regardless of cause. Pregnancy-related death: The death of a woman during pregnancy or within 1 year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. Pregnancy-associated, but not related death: The death of a woman during pregnancy or within 1 year of the end of pregnancy from a cause that is not related to pregnancy. Pregnancy-associated, but unable to determine pregnancy-relatedness: The death of a woman while pregnant or within 1 year of pregnancy, due to a cause that could not be determined to be pregnancy-related or not pregnancy-related.
2022 Joint Biennial Report Review of 2019 submitted cases (N=118): 52 (44%) pregnancy-related 42 (36%) pregnancy-associated, but not related 24 (20%) pregnancy-associated, but unable to determine relatedness Main findings: 90% of cases were preventable Non-Hispanic Black women were disproportionately impacted 27% of cases were violence-related
Contributing Factors Patient/Family Provider Clinical skill/quality of care Failure to screen/inadequate assessment of risk Delay in referring or access to treatment Discrimination Lack of knowledge regarding importance of event, treatment or follow-up Chronic disease Lack of access/financial resources Delay or failure to seek care Mental health conditions Lack of knowledge regarding importance of event, treatment or follow-up
Contributing Factors Facility & System Community Failure to screen; inadequate assessment of risk* Clinical skill/quality of care Delay in referring or access to treatment Lack of standardized policies & procedures Lack of knowledge regarding importance of event, treatment, or follow-up Lack of continuity of care** Lack of access/financial resources** Discrimination** Lack of family/friend or support system Lack of access/financial resources Unstable housing Discrimination Lack of knowledge regarding importance of event, treatment, or follow-up * = facility only ** = system only
02 Initial Project
Background Plan Formation of CMHE Maternal Health Team in January 2019 Awarded Kleberg Scholar grant to implement maternal health project Community partners: Driscoll Health Plan (DHP), LRGV AHEC 10-week Prenatal Health curriculum created by Gateway Community Health Clinic Facilitated by promotoras using CHC model Inclusion criteria: 1st trimester pregnancy enrolled in DHP
Timeline Formation of Maternal Health Team Implementation phase Lesson Learned follow-up Feb-July 2019 Aug-Nov 2019 June-Dec 2020 Feb 2019 Dec 2019 Prep work, focus groups, recruiting Dissolution of maternal health CHC
03 Lessons Learned
Consolidated Framework for Implementation Research (CFIR) Innovation Outer Setting Inner Setting Individuals Implementation Process
Program Descriptions LRGV Maternal Health Clubs CenteringPregnancy at FHC Ten-week prenatal health curriculum Facilitated by CHWs using the CHC model Participants: pregnant women enrolled in DHP Recruited via phone calls from the DHP promotoras Goals: increase maternal health, mental health, and health literacy among pregnant women in the LRGV National non-profit organization that provides group prenatal care CenteringPregnancy incorporated into FHC clinics in 2014 Replace their prenatal care visits Led by Family Medicine residents Goals: increase women s health outcomes, social support, self- care, and self-confidence
Our process Key informant interviews Coding Thematic analysis
Key Informant Interviews LRGV Program Guided by CFIR framework Interview sections: Demographics Needs/barriers Intervention characteristics Inner setting Driscoll Health System LRGV AHEC CMHE Maternal Health Team CenteringPregnancy Program manager Volunteer
Coding Code Families Intervention characteristics Enabler Barrier Program structure Incentives Recruitment strategy Buy-in Inner setting support External networks Mutual benefit Positive competition Adaptability Partnership mistrust Perceptions of commitment Inflexibility Lack of buy-in Cultural barriers Participant barriers Limited target population Redundancy Structural barriers Miscommunication
Themes Degree of Buy-In Tension for change Implementation climate Partner trust & communication Organizational adaptability Inner setting support
Degree of Buy-In Definition: Stakeholder s degree of willingness to accept and actively support the implementation of the program CenteringPregnancy Quotes: We had provider buy-in from higher - from administration and from our attending providers - the ones that teach our program. They had to want it for our residents that go through our program. It took a little bit of administrative buy-in not just a money thing at first because at the startup it didn t cost us anything - it was the time, pulling our providers and staff for the training. But we were able to do it - we did it on Saturdays. LRGV Maternal Health Club Quotes: With the time that it was presented to us, with all the changes and everything that was going on in our program here, it just made it difficult to give [the CHC] more support. And when we saw the goal for the CHC, we knew it was aligned with our mission of teaching our members how to be healthy. Plus, we also wanted to provide an outlet for [our members], to have that network to socialize with another mom. Because many of our members are single parents, and they don t have the support and the community they necessarily could use and benefit from.
Implementation Climate Definition: The atmosphere surrounding the pre-implementation phase, including the intervention source, the program structure, and stakeholders perceptions about project implementation and participants CenteringPregnancy Quotes: I think sometimes for the women it felt like it was a lot of appointments, but I think in prenatal care, you generally have a lot of appointments. We have 36 residents go through our program at a time. They saw it as a learning tool. If we offered CenteringPregnancy, it would be a way for them to learn. I mean, we hear nothing but, Oh my gosh, I didn t know anything about OB until I led the Centering Pregnancy class. It is like they were learning too. LRGV Maternal Health Club Quotes: I think the number of sessions we were trying to get our members to come to would have been an issue. And that was something I know we anticipated We previously had our maternal baby program in 3 different sessions focusing on trimesters. Due to the lack of participation, we condensed and moved to one shower. I think [club implementation is attainable] just seeing from our focus groups that the issues are present. Not only in young pregnant women but in their families having to help raise each other s children or go through a pregnancy I feel like the interest is there, that s the first thing.
Partner Mistrust & Miscommunication Partner Trust Definition: Descriptions and examples of trust, or a lack of trust, between organizations and persons working together to implement a prenatal program, including both explicit statements and allusions Partner Communication Definition: Descriptions and examples of communication between stakeholders and the impact this has on team dynamics There is a lack of data for this theme with CenteringPregnancy. LRGV Maternal Health Club Quotes: So if they had great attendance there, did our partners not do enough to encourage those ladies to attend? I also don t know if the people who were helping us from the health system, if they really understood our goal at the end of the day. So maybe even just better communication with them to begin with I think we would have to partner up with another team that s highly invested in the project.
Tension for Change Definition: Degree to which stakeholders perceive the current situation as intolerable or needing change. CenteringPregnancy Quotes: I know we did want to offer something that no one else had. And we wanted to kind of be the first ones...I think we had been stagnant for so long with our traditional care, and it was like, Wow, for us to even think about offering [a program like this] to the people we serve. LRGV Maternal Health Club Quotes: I think the CHC would be better because they can stray, you know, and ask questions and things like that. We really don t have the time in our two hours at the baby showers [for the women] to ask many questions and things like that. I think [the curriculum] was repeated information,.. They were already given this information at Driscoll and now we are bringing it back but in a different format. So I think it is just that we were duplicating the same information and maybe they just didn t want to hear it. That is what the ladies told us, the two ladies that were there: it was the same information and they didn t feel like they needed to hear it again.
Organizational Adaptability Definition: Degree of willingness to adapt when faced with an obstacle CenteringPregnancy Quotes: We have rules. CenteringPregnancy Headquarters has their own set of rules. But we kind of... it is just a guide. Because it says not to bring children, but we have to be okay with that because a lot of our moms don t get daycare. So we have a little area we ll let them play, and we have people that have donated toys and coloring books and colors. So we just kind of deal with it. LRGV Maternal Health Club Quotes: We also took an approach to call from our local number to ensure [the members] would be curious enough to answer the phone versus calling from an 800 number. So those were some of the things that we put in place. A lot of it was calling local [women], making sure that the messages, if any were left, were being left in a language they would hear, either English or Spanish. We made sure to provide the different [class] times. We adjusted times too. We called at different times as well Maybe inviting everyone, not only pregnant women. Maybe it s because your study is only for pregnant women so we need to do that. But if we can open it up [to everyone], it s better.
Inner Setting Support Definition: Collaboration and support between organizations or persons working together to implement a prenatal program CenteringPregnancy Quotes: We get a lot of help and support from the headquarters in Boston. So we can just say, Hey, we are having a problem with this. And we usually get back all kinds of feedback. [CenteringPregnancy Headquarters] constantly has sessions where we can learn how to do different activities better. People are always writing in, saying We have this issue going on, has anybody encountered that before? What did y all do? What helped? LRGV Maternal Health Club Quotes: I think we finally decided on Brownsville because we already had a good partner there, which was AHEC. And I think just having enthusiastic partners like that is what ended up making it possible to have at least one or two sessions and at least survey some of these women to see what issues they are facing. So just finding partners who have the same passion for the topic and being able to also travel down [to Brownsville] ourselves helps.
0 4 Conclusions
Lesson 1 Adjust target population for community-based maternal health education program based on how integrated the program is into already existing prenatal healthcare appointments & obligations.
Lesson 2 Stakeholder leadership with high relative priority is integral to community-based maternal health education programs.
Lesson 3 Community-Based Maternal Health Education Programs are most successful if developed and promoted from within a partnering organization, allowing for increased internal buy-in and more seamless integration into the culture of partnering organizations.
Limitations Data imbalance 2 vs. 6 interviews Time lapse ~9 months between attempted implementation and interviews Differing organizational structures Impacted partner miscommunication and mistrust theme
References: 1. Texas Maternal Mortality and Morbidity Review Committee and Department of State Health Services Joint Biennial Report 2022; https://www.dshs.texas.gov/sites/default/files/legisl ative/2022-Reports/Joint-Biennial-MMMRC-Report- 2022.pdf Consolidated Framework for Implementation Research; https://cfirguide.org/constructs/ 2.
Acknowledgments Adriana Dominguez, BAIS, CCHW Ashley Weaver Rose Mary Santos Jason Rosenfeld, MPH, DrPH Melanie Stone, MPH, MEd Ruth Berggren, MD Olivia Hoffstadt (Gensheimer), MD Caitlin Stanley, MS3 Juana Escareno, CHW-I Esmeralda Ibarra, BS, CHW
Thank you!!! Do you have any questions? autumnchidester.eras2023@gmail.com +1 (806) 681-3195 CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon and infographics & images by Freepik Slidesgo Flaticon Freepik
