In Hawaii, Native Hawaiian women have the highest perinatal morbidity and mortality rates. Reducing these health disparities is our long term goal. A community-based participatory research approach, which facilitates a collaborative process between university and community with both partners having equality within this process, has been used to gather preliminary data and to plan the current pilot intervention study. This intervention addresses the components of perinatal risk reduction: health promotion (breastfeeding, effective parenting), disease prevention (preventive prenatal/postpartum/well-baby care use, immunizations), and building effective social support networks. It incorporates the existing evidence-base on perinatal risk reduction through home visiting, social support and lactation management framed within a Native Hawaiian cultural context. A culturally-relevant Hawaiian model frames this intervention that incorporates Native Hawaiian definitions of support (Pohai Ke Aloha) and encourages participation by each participant's support person(s) or `ohana. The purpose of this study is to trial the feasibility and efficacy of this intervention and to increase understanding of how targeted interventions increase risk-reduction behaviors through a collaborative context-based process.
The aims of this study are: 1. Compare use of perinatal risk reduction behaviors (prenatal/postpartum preventive health care use, breastfeeding pattern, effective parenting and social networking) in first-time Native Hawaiian mothers who receive the perinatal risk reduction intervention and those who receive the usual perinatal care (control group). 2. Compare use of infant preventive health (immunizations, well-baby visits) use and infant growth in the perinatal risk reduction intervention group and the usual perinatal care (control) group. 3. Describe participants' and their `ohana (family) experiences of the social support intervention. A mixed method design is used that has a qualitative component (Aim #3) and a quantitative longitudinal two- group experimental component (Aims 1 & 2). Sixty Native Hawaiian first time mothers over the age of 17 who have decided to breastfeed and do not have substance abuse issues, preterm infants, infants requiring intensive care or other major medical and/or obstetrical problems will be recruited and randomly assigned into the control or intervention group. All participants will receive the usual perinatal case management services provided by the community health center where they receive health care. The intervention consists of routinely scheduled home visits by professional perinatal staff that provide enhanced prenatal and postpartum education and facilitation of social support networks using the culturally relevant model. Observational, retrospective medical record and participants' self-report data will be collected. Findings will be used to develop intervention protocols that can be used and tested in subsequent larger clinical trial research. The purpose of this study is to reduce the risks that have been associated with the high perinatal health disparities found in the Native Hawaiian population by trialing a multidimensional risk reduction intervention. Improving the health of mothers and infants is the goal of this research.
