Identifying and Addressing Social Determinants of Health in Pregnant Women - 1 ABSTRACT 2 Maternal mortality rates are three times higher among non-Hispanic Black (hereafter referred to as Black) than 3 White women. Infant mortality rates are more than twice as high for Black than White infants. The National 4 Institute of Minority Health and Health Disparities Strategic Plan identifies interventions to address the 5 egregious disparities in severe maternal mortality and morbidity between Black and White women as an 6 important unmet need. This project aims to overcome these disparities by addressing the Social Determinants 7 of Health (SDoH) impeding the health and well-being of Black pregnant women. SDoH are social, economic, 8 and environmental conditions that have been found to mediate between racial and ethnic health disparities and 9 these tragic maternal health outcomes. Yet no standard of care exists for how and when to screen for health- 10 related social needs in pregnancy, let alone address them. Clinicians acknowledge the risks associated with 11 SDoH in pregnancy, yet few feel equipped to address them with their patients. Moreover, Black pregnant 12 women do not trust clinicians to discuss social needs due to fear of judgment, stigma, or even loss of parental 13 rights. The product of this SBIR project is personalized and culturally competent chatbot conversations to 14 screen and address SDoH for Black pregnant women. We have developed a mobile health app to seamlessly 15 monitor and screen for maternal mood disorders for women from early pregnancy through 36 months 16 postpartum via chatbot, then refer to a behavioral health consultant when risk is detected. A preliminary study 17 demonstrated our app had a 10X higher 30-day user retention compared to an average mental health app. 18 This project will augment our existing app to also screen pregnant women for SDoH each trimester and refer 19 them to local social support services. The chatbot will follow up weekly until the need is addressed or refer to a 20 human case worker if unaddressed after a month. Integrating SDoH screening and referral into a mHealth app 21 that already screens and treats maternal mood disorders is an innovative approach to identifying and 22 addressing multiple risk factors for maternal morbidity and mortality. In this Phase I SBIR, we will demonstrate 23 the chatbot-delivered SDoH screening and referral is feasible, and it is acceptable for Black pregnant women. 24 These outcomes will inform the design and development changes needed in Phase II, before conducting a 25 randomized controlled trial to demonstrate our platform delivers useful SDoH resources and referrals and 26 reduces race-related stress. Demonstrating effective outcomes on these measures will provide us with the 27 validation needed to sell the Poisera platform to Medicaid programs, a $1.5 billion annual market size. The 28 long-term impact of this project is identifying and addressing both SDoH and maternal mood disorders among 29 the half a million Black pregnant women annually to ultimately reduce the inequitable rates of maternal 30 morbidity and mortality.
