The overall purpose of this application is to evaluate the efficacy of an intervention designed to decrease health disparities in pregnant, emotionally distressed minority women. This randomized controlled trial will test a six session (spaced over 18 weeks) cognitive behavioral skills building (CBSB) prenatal care intervention (specifically designed and based on prior research for pregnant minority women experiencing emotional distress) at two sites. To meet the specific aims of this study we will:
Specific Aim 1. Use a RCT to evaluate the short- and more long-term efficacy of the COPE-P program to improve healthy lifestyle behaviors (nutrition and exercise), psychosocial health, and birth and post-natal outcomes in pregnant emotionally distressed minority women as compared to an attention control group. Hypotheses 1a (primary outcomes). Immediately after the COPE-P program, at 4-6 weeks postpartum (3 months post intervention), and at 6 months postpartum (8 months post intervention), COPE-P participants will report higher healthy lifestyle behaviors, and less anxiety, stress and depressive symptoms than will the attention control participants. Hypothesis 1b (secondary outcomes). COPE-P participants will demonstrate more appropriate pregnancy weight gain, better birth outcomes (mode of delivery, birth weight, and gestational age), more appropriate postpartum weight loss, and better breastfeeding outcomes than attention control participants.
Specific Aim 2. Examine the role of cognitive beliefs and perceived difficulty in leading a healthy lifestyle in mediating the effects of the COPE-P program on healthy lifestyle behaviors and psychological symptoms in minority pregnant women. Hypothesis 2 (theory building exploratory). The effects of the COPE-P program on participants' healthy lifestyle behaviors and levels of anxiety, stress and depressive symptoms will be mediated by beliefs about their ability to make healthy lifestyles choices and their perceived difficulty in leading a healthy lifestyle. Exploratory Aim. Explore characteristics that may moderate healthy lifestyle behaviors, psychosocial health, and birth and post-natal outcomes (e.g., race/ethnicity, income, age, parity, language, level of education, marital status). There is an urgent need to develop and evaluate theoretically-driven, culturally appropriate coping interventions that can be embedded in routine prenatal care and be widely scaled if found to be efficacious.
A randomized controlled trial will test a cognitive behavioral skills building intervention (COPE-P) in Black and Hispanic women experiencing emotional distress in two sites (New York and Ohio) to determine if the intervention leads to better health behaviors, better psychosocial health (anxiety, stress, and depressive symptoms), and improved birth and post-natal outcomes in women experiencing emotional distress. Developing scalable prenatal interventions designed to improve birth outcomes as well as maternal physical and psychosocial health is essential to decrease health disparities in pregnant minority women.
