BACKGROUND: Rates of maternal mortality and severe maternal morbidity are
higher in New York City (NYC) than nationally, with Black birthing people experiencing the worst maternal outcomes, followed by Latina/e and Asian/Pacific Islander birthing people. This study aimed to understand the barriers and facilitators to engaging in maternal self-care and maternal health care to support the design of a stakeholder- informed maternal community health worker (CHW) model in NYC. The study also identified key intervention components and strategies for adoption, implementation, and sustainability.
METHODS: In-depth interviews were conducted with prenatal and postpartum people (N=38) from a large teaching hospital in Upper Manhattan serving a racially and ethnically diverse patient population and with a cross-section of professionals (N=15) delivering maternal health care. Interviews took place between November 2020 and
August 2022. Thematic analyses were conducted to uncover findings to inform program vii
design, with the Intervention Mapping framework guiding this process.
RESULTS: Findings reveal a range of barriers and facilitators to maternal self-care
and health care engagement. Barriers included lack of transportation and childcare, delayed introduction of resources by the health care team, lack of care continuity, and experience with and concerns about disrespectful or discriminatory care. Additional barriers from the COVID-19 pandemic included disruptions to social support networks, childcare, and health care experience. Facilitators included information and advice from family, friends, and social media, positive coping skills, and trusted relationships with obstetric providers.
Prenatal and postpartum participants recommended program components that provide emotional and instrumental support, and viewed the CHW as a someone they can trust to provide support and advice. Maternal health professionals recommended patient education and skills-building, and a focus on patients with high-risk pregnancies and chronic conditions. Maternal health professionals also recommended early staff and patient buy-in, clear definition of the CHW role, strong supervisory structure, and external seed funding.
CONCLUSION: A needs and assets assessment using the Intervention Mapping framework was critical to design a stakeholder-informed and evidence-based maternal community health worker model. These findings include lessons learned for similar health systems seeking to develop community-based care models to address maternal health inequities and improve outcomes. / 2026-01-03T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47898 |
| Date | 04 January 2024 |
| Creators | Ives, Brett L. |
| Contributors | Declercq, Eugene R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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