Evaluating the effectiveness of an integrated group postpartum and well-child care model on maternal and child health outcomes

Johns Hopkins University, Baltimore MD

Investigators

Abstract

The building and then testing of high-quality health care service delivery models and practices is urgently needed to substantially reduce global maternal and infant health disparities. Low-resource settings have some of the worst perinatal health outcomes globally. A constellation of health system and social factors contribute to maternal and infant morbidities, including low rates of receipt of health care and preventive services. Unaddressed postpartum morbidities (e.g., depression) can directly impact the health and well-being of the infant, for whom the first year of life is a crucial time for their long-term health. As such, there have been calls for a redesign of maternal and infant health services and systems. Group care is a promising strategy for maternal and child health care redesign, but has primarily been tested in the antenatal setting. Few studies examine extending group care into the postpartum period, integrating postpartum and well-child care in low resource settings. However, opportunities exist to address ongoing maternal and infant morbidities while supporting the transition of the dyad from postpartum to primary care during this critical time in the life course. In 2022, we collaboratively adapted an evidence-based group healthcare model and co-designed an integrated group postpartum and well-child care model that extends postnatal care to 12 months while integrating it with well-child care so that the health needs of the dyad are addressed simultaneously. This model brings together 8-10 postpartum women with similarly aged infants to engage in care together. Each visit is 2 hours, with the first 30–45 min devoted to standard clinical health assessments for the dyad and participation in self-assessments, followed by 75–90 min of interactive health promotion activities. Using a cluster randomized control trial with mixed methods, we will assess the impact of this innovative and proactive group healthcare model at 16 clinics. We will use the same 3-Step Implementation Model that allowed our team to successfully implement and sustain group prenatal care at seven clinics. We will test the hypothesis that compared to usual care, infants will have increased vaccination rates and women will have decreased postpartum depression, anemia, and hypertension, and more optimal secondary outcomes for the dyad, such as uptake of family planning, exclusive breastfeeding, childhood development, and nutrition. We will also qualitatively explore the health and health-related social needs that arise in the 12 months after birth for both women and their infants and identify clinic- and patient-level implementation facilitators and barriers. This study will be the first to conduct an adequately powered trial of an integrated group postpartum and well-child care model in an LMIC. This rigorous study will have important public health policy implications for the U.S, where maternal morbidity rates are unacceptably high. Results will provide clinical evidence for improved maternal and infant health care in the first year postpartum.