There are striking inequalities by income level in important maternal child health outcomes, including rates of unintended pregnancies, breastfeeding duration and preventative or specialty health care uptake after delivery. The long-term health consequences of these disparities are well documented. An important, but under studied contributor to these health disparities is adherence to postpartum care. High quality postpartum care targets immediate and long-term maternal and child health needs through provision of contraception, support for breastfeeding, screening for cardio-metabolic complication of pregnancy and linkage to care for high-risk women. Adherence with the postpartum visit among economically disadvantaged women, however, is poor. The disparity in rates of postpartum care demonstrates that the current care model does not engage all women and disproportionately fails our most vulnerable mothers and babies. The overarching hypothesis of our research agenda is that an intervention grounded in empirically derived concepts of behavioral economics will improve compliance with the postpartum visit and promote equality in maternal child health. To this end, we have designed an innovative, scalable, and affordable web-based solution- Healthy Beyond Pregnancy. Healthy Beyond Pregnancy uses proven tenets of behavioral economics to target two critical drivers of behavioral change-- awareness and willingness. The four cornerstones of our program are: (1) combating information overload with a personalized approach to postpartum education and care, (2) overcoming self-control issues by formalizing the postpartum visit with a commitment contract, (3) addressing limited attention and increasing awareness by nudging women in the immediate postpartum period via automated text messaging and (4) incentivizing completion of the postpartum visit. Our web-based platform is built, usability testing is complete, and we successfully performed a pilot feasibility trial demonstrating our ability to recruit and enroll subjects at a rate needed for this application. Our next objective-- the focus of this proposal-- is to conduct a pragmatic clinical trial to test our hypothesis that exposure to HBP will result in a 30% increase in compliance with the postpartum visit and in turn lead to measureable improvements in uptake of effective contraception, breastfeeding duration, and linkage of care for high-risk women. We have assembled a multi-disciplinary team with the knowledge and expertise necessary for this project. We have also engaged the UPMC Health Plan, an important stakeholder, as they are the largest insurer of economically disadvantaged pregnant patients in our busy maternity hospital, to support this scientific endeavor. Successful completion of our aims will provide the foundation for a dissemination trial with the primary objective of narrowing the gap in short-interval pregnancies, short breastfeeding duration and inadequate follow-up after complicated pregnancy.
There are striking inequalities by income level in both immediate and long-term maternal child health outcomes. An important, but under studied contributor to these health disparities is adherence to postpartum care. To narrow these health disparities, we have designed an innovative, scalable, and affordable web-based solution (Healthy Beyond Pregnancy) based on principles of behavioral economics to help new moms prioritize their postpartum health.
