Maternal Health Navigator intervention to reduce disparities in severe maternal morbidity and mortality

Maternal mortality in the US has increased over the past five years and is associated with alarming disparities, disproportionately affecting individuals of low socioeconomic status. Severe maternal morbidity (SMM), much more common than maternal mortality, refers to a broad range of pregnancy-related complications and is associated with the same disparities as maternal mortality. Without treatment, SMM can lead to preventable maternal deaths. Interventions to reduce SMM disparities have lacked specific mechanisms to reach at-risk women within communities experiencing heightened SMM risks. Community-based patient navigation is an emerging successful approach to improving community health. We propose a community-centric intervention, called Pathways through Pregnancy (PTP), with the goal of decreasing SMM through outreach by community-based health navigators that help pregnant women identify and surmount barriers-to-care that lead to SMM risk. PTP navigators will be supported by a smartphone app called Pathways. Three Phase I aims are proposed: Aim 1) design the Pathways through Pregnancy (PTP) intervention with input from pregnant and recently pregnant women, community members, and healthcare personnel through a user-centered, participatory design approach, using data from a low-income study community in Baltimore; Aim 2) design and prototype the Pathways app, drawing on multiple stakeholder perspectives and using a user-centric participatory process to produce an interactive Pathways prototype; Aim 3) conduct a multi-perspective assessment of PTP and the Pathways app for feasibility for further development, translation, and commercialization, using both qualitative and quantitative methods and criteria of perceived usefulness of PTP overall and usability of Pathways. PTP is a community-focused personalized intervention to reduce SMM risk among low-income women (including those who may be disengaged with the healthcare system). It has a potential for substantial impact to improve maternal health outcomes. A successful PTP intervention will provide women at risk of SMM with personalized educational information on peripartum risks and care, help them dispel misinformation, guide them to earlier prenatal care, help them achieve better maintenance of postnatal care, identify barriers to care and wellness; and provide them with resources to overcome or mitigate those barriers. This emphasis positions PTP to find, triage, and guide pregnant women in the community regarding their perinatal health needs.