Does expanding a federal Healthy Start home visiting case management model, to include a nurse, nutritionist, and clinical mental health counselor, impact selected health outcomes in high risk African American women before and after pregnancy?
The Gadsden federal Healthy Start Project provides outreach, education, and case management services in a small rural community in north Florida with significant disparities in infant death rates for African Americans.
The leading cause of Black infant death in this community is prematurity due to poor maternal health, according to the Perinatal Periods of Risk “adapted” model (used for small communities) conducted in 2009.
Project needs assessments revealed significantly high rates of stress and depression as well as high rates of obesity, high blood pressure, diabetes, and other chronic diseases in its pre-interconception participants.
To address these risk factors, the home visiting case management staff, including 4 professional social workers, was expanded to include a professional nurse, nutrition educator, and clinical mental health counselor.
All staff were trained on the new “Bio-psychosocial” interdisciplinary team approach and how it works with the participants.
All team members have a clear understanding of the goals and objectives of the model and how they are translated into individualized case planning.
A study was conducted that looked at single group pre-post test differences for the following variables: blood pressure, physical activity, water intake, Body Mass Index, waist circumference, depression, stress, and health literacy.
Participants were non-pregnant African American women (14-44) who were assessed as being at risk for a subsequent poor birth outcome. (CDC recommended risk criteria)
The study included 31 participants who were enrolled in the program for case management services for at least six months between January and December 2010.
Program evaluation goals were established to measure progress and all goals were exceeded:
Blood Pressure Goal (25%): Exceeded by 50%
Physical Activity Goal (35%): Exceeded by 1%
Water Intake Goal (35%): Exceeded by 14% Significant alpha = .05
Body Mass Index Goal (35%): Exceeded by 3%
Waist Circumference Goal (5%): Exceeded by 56% Significant alpha =.05
Depression Goal (10%): Exceeded by 29%
Stress Goal (10%): Exceeded by 43% Significant alpha =.05
Health Literacy Goal (25%): Exceeded by 19% Significant alpha =.05
A two tailed t-test (alpha =.05) was conducted for each of the pre-post test mean differences.
Preliminary findings suggest that a bio-psycho-social interdisciplinary team approach does have an impact on selected health outcomes of high risk African American women (14-44).
This pilot study examines the impact of peer health advocacy (PHA) upon knowledge and behaviors concerning risk factors associated with premature birth and infant mortality. In addition, the PHA’s intervention seeks to increase acceptance of case management services and attendance at pre-natal visits by educating women through weekly health education and peer support groups. By (1) increasing knowledge and advocating behavioral change related to risk factors, (2) increasing attendance at prenatal care appointments and case management services, this intervention seeks to reduce negative birth outcomes among rural African-American women. PHA’s are paraprofessional women who reside in a rural Southeast community and act as facilitators in health education and support groups with at-risk pregnant women and those parenting children under the age of two. PHA’s receive training in risk factors that enable them to provide education concerning issues including nutrition, douching practices, stress management, maternal infection, periodontal disease and pre-natal care. The PHA’s are trusted members of the community and their intervention with clients seeks to enhance the follow through of at-risk women with traditional health care and social service providers. PHA’s are often able to serve as cultural mediators for women who are reluctant to work with traditional care providers.
Sample and Setting Data was gathered from various locations in a rural community in North Florida where the health education groups are conducted. The study sample includes both adolescent and adult women who were pregnant or parenting children under the age of two. Approximately 200 women are served each year through the intervention. Data was gathered over an 18-month period, ranging from January of 2004 to June 2005.
Design A One-Group Pretest/Post test design was conducted to evaluate study outcomes. This pilot project seeks to evaluate the impact of the PHA intervention on outcome variables including (1) changes in knowledge related to risk factors associated with infant mortality and prematurity (2) behavior changes related to risk factors associated with infant mortality and prematurity (3) use of case management and heath care services (4) impact on gestational age, birth weight and infant mortality. Infant mortality rates are compared with aggregate data on women who received pre-natal care through the County Health Department from January of 2004 to June 2005.
Research Questions (1) What is the impact of the peer health advocacy intervention on knowledge and behaviors related to risk factors of prematurity/ infant mortality? (2) Does intervention participation increase acceptance of health care and social services among participants? (3) Are infant mortality and prematurity rates lower for participants than non-participants (using a comparison sample from the County Health Department)?
Results Self-report data from pre and post-test surveys indicates statistically significant change in several key areas, including knowledge of nutrition, maternal infection, and pre-term labor. Participants reported changes in behavioral change in the areas of stress management and douching behavior. The majority of participants reported attendance at all pre-natal visits and increased satisfaction with health care providers. Results showed increased use of area social services for domestic violence, GED preparation, and mental health and job counseling. Preliminary findings indicate gestational age and birth weight data are higher than the county average.
Innovations in practice and potential for inter-disciplinary collaboration are discussed. Additionally, examples of practical applications in social work and health care settings will be discussed. Limitations of this project and future directions for research in this area will be forwarded. Finally, implications for social justice and advocacy will be advanced.
Title of Publication: Health Advocacy: An Empowerment Model for Pregnant and Parenting African-American Women in Rural Communities
Journal of Family & Community Health:
July/September 2006 – Volume 29 – Issue 3 – p 221-22