PARITY: An integrated community care and strengths-based technology intervention to improve maternal wellness and reduce health disparities in Black women - Project Summary In the United States, excessive rates of maternal morbidity and mortality are a public health crisis borne disproportionately by Black women. Decades of research have failed to ameliorate this crisis. Most research involving Black maternal morbidity and mortality is structured according to a deficit-focused framework, which highlights the deficiencies and insufficiencies of individuals within the examined community. Clinical practices resulting from such research normalize and blame individuals for the maternal health disparities that Black women experience. This proposal addresses maternal morbidity and mortality and the impact of deficit-focused health care models on maternal health by leveraging the protective assets of Black communities and individuals, use of integrated supportive care, and a wellness-based mobile technology intervention to reduce maternal morbidity, mortality, and cesarean birth and improve wellness-related behavioral outcomes. Our goal is to offer pragmatic, community-centered solutions to maternal health disparities that build upon the inherent strengths of Black individuals and Black communities . Based on our theory of maternal adaptive capacity and building upon our previous work, we have developed a novel program called Protective Assets Reinforced with Integrated care and TechnologY (PARITY). We propose a randomized trial and mixed methods evaluation involving 384 Black pregnant women, divided between PARITY program participants and information control (IC). Our innovative, community-based intervention will identify the strengths and protective assets of intervention participants and of their communities. Within the community setting, PARITY participants are matched with Black doulas who will provide strengths-based guidance, support, and community resources throughout the pregnancy continuum. PARITY participants will also use a novel HIPAA compliant mobile technology platform that promotes wellness behaviors, empowered strengths, and healthcare adherence while offering additional opportunities to connect with the community-based doula. The specific aims of this proposal are: (1) Determine the effects of the PARITY program, as compared to IC, on severe maternal morbidity (primary outcome), maternal mortality, and cesarean birth (secondary outcomes) in Black pregnant women; (2) Determine the effects of the PARITY program on wellness-related behavioral outcomes including nutrition, physical activity, sleep, and healthcare adherence; (3) Assess whether changes in maternal outcomes are mediated by changes in wellness-related behavioral outcomes and whether the effects of PARITY on the wellness-related behavioral outcomes are mediated by changes in empowered strengths; and (4) Identify barriers, facilitators, and perceived benefits of the PARITY intervention. The proposed research offers a comprehensive, innovative approach to maternal morbidity and mortality reduction by integrating a strengths-based framework, novel technology, and peer-based community support, while addressing healthcare access, healthcare quality, and the social needs of each participant.
