Developing a community-driven innovation agenda to prevent severe maternal morbidity and other serious complications of pregnancy and postpartum - The purpose of this proposed study is twofold: First, we propose to develop a deeper understanding of the experiences of severe maternal morbidity among survivors, their families, and their communities, and explore the boundaries of what is considered severe maternal morbidity (SMM) versus other severe complications of pregnancy. Second, we propose to develop community-driven intervention strategies to improve maternal, child, and reproductive health outcomes. All work will be guided by and developed in collaboration with an established community advisory board focused on SMM and maternal health. In Aim 1 we will use a lifecourse lens to conduct in-depth interviews and surveys with survivors of SMM. For Aim 2 we will recruit partners, family members, and support persons of SMM survivors to participate in interviews and surveys to understand their unique experiences which have often been overlooked. In these aims we will explore and describe the experiences, challenges, assets, and strengths of women affected by severe maternal morbidity and other serious complications of pregnancy; and characterize the experiences of partners, family members, and support persons. We will identify long-term consequences of SMM, evaluate social drivers of health of SMM survivors, and better define the boundaries of what is considered SMM from the patient and community perspective vs. a medical or epidemiologic perspective. We will identify causes, contributing factors, and consequences of SMM and other harms experienced by survivors and their families or support persons; survivor, family, and community strengths; health systems structures; and policy implications. In aim 3 we will be guided by causal mapping from Aims 1&2 and community-based prioritization of these factors in selecting priorities for intervention. We will then prototype, in collaboration with SMM survivors and family members, community partners, clinicians, community birth workers, administrators, and policy makers, an intervention strategy or strategies to address their priority concerns in maternal, child, and reproductive health. We will use the 6 Steps to Quality Intervention Design model to enhance prototype readiness for feasibility and acceptability testing as well as future large-scale testing, implementation, and dissemination. This study integrates the NINR strategic plan lenses prevention and health promotion, and systems and models of care to develop community-driven interventions to prevent SMM; mitigate the impact of SMM on survivors and their communities; and promote positive maternal, child, and reproductive health outcomes.
