Maternal and Child Health Research Consortium - The proposed Perinatal Research Collective (PRC) will conduct a series of collaborative research studies, informed by stakeholders, to improve outcomes for women with hypertensive disorders of pregnancy (HDP). HDP is a leading cause of maternal health complications and death. Even if hypertension resolves within six weeks after delivery, women with HDP are significantly more likely to develop cardiovascular disease (CVD) in the future. Our three proposed studies are collectively known as Project PITCH (Perinatal Incentivized Treatment and Care for Hypertension). First, we will conduct a co-development study using semi-structured interviews and human-centered design activities to optimize two evidence-based interventions: Care Navigation and Incentivized Care. The goal of these interventions is to promote engagement in important health activities related to HDP and CVD, such as blood pressure monitoring, primary care visits, routine lipid and glucose monitoring, and addressing health-related social needs. Care Navigation helps women overcome barriers to engaging with the healthcare system, adhering to clinical plans, and connecting to social services. Incentivized Care provides women with HDP incremental payments in the year postpartum to encourage care engagement and support health behavior changes. Research methods used in Study 1 will ensure that the interventions are acceptable to the target population and feasible to implement. Second, we will conduct an intervention study comparing the effectiveness of Care Navigation alone to Care Navigation combined with Incentivized Care. Participants will be randomly assigned to one of two study arms and monitored for one year. We will compile outcome data from our organization’s Magee Obstetric Maternal & Infant (MOMI) Database and Biobank for analysis. Statistical analyses will help us understand how each study arm impacts engagement in guideline-based HDP/CVD care during the postpartum year and achievement of blood pressure control. We will also evaluate the impact of the interventions on different patient subgroups, such as women with public versus private insurance and those living in rural versus urban/suburban areas. Qualitative Study 3 will take place concurrently with Study 1. We will conduct key informant interviews to explore opportunities for intervention sustainability and scalability. Additionally, we will conduct semi-structured interviews with Study 2 participants to examine barriers and facilitators to intervention engagement and understand how the interventions influence their attitudes, behaviors, and overall health outcomes. The insights gained from these interviews will be crucial for refining and optimizing the interventions to ensure their long-term effectiveness and broader applicability. Importantly, we will involve early career investigators in conducting Project PITCH studies and disseminating findings. We will leverage existing training programs within our organizations to offer career mentorship, guidance on career trajectory, and connections to professional networks. We will provide scientific mentorship on study design, development, and publication to help early career investigators transition to scientific independence.
