Fourth Trimester-A Web-based Tool For Postpartum Care To Address The needs Of Underserved Women

PROJECT SUMMARY/ABSTRACT The postpartum period is a critical time, and more than half of all maternal deaths occur postpartum. Black women are 3-4 times more likely than white women to experience maternal mortality. In the US, 1 in 4 women do not have a timely postpartum visit, and adherence is even lower for women on Medicaid managed care plans. Our Parent Grant (R43MD014923) was funded to develop a program that educates and supports mothers in the ‘fourth trimester’, to address the physical, cultural, and knowledge barriers to quality postpartum care. The COVID-19 crisis presents novel health and economic challenges for this vulnerable population. Because of the myriad challenges COVID-19 presents, and the ways in which it will transform postpartum care, it is our responsibility to revise the scope of our project to address COVID-19 in our research and to add features to the tool we are building to address immediate concerns and needs related to this crisis. The challenges of the current pandemic will have a lasting impact for minority and economically at-risk populations because fundamental health disparities persist, further inhibiting already limited access to timely and appropriate care. Racial and ethnic minority women are more likely to have gaps in health insurance coverage, a situation further complicated by the higher proportion of unemployment during the pandemic and ensuing economic crisis. In addition, there are over 30 million small businesses in the US hard hit by this dual crisis – many of which are in the healthcare sector. They are critical for providing services to this vulnerable population and are most at risk of losing their businesses during times of economic instability. Research focused on the concerns, needs, and health of underserved women, and the development of digital tools to reduce gaps in care which specifically address barriers exacerbated by COVID-19, are essential to protect the health of mothers and their babies. Our strong relationships with community groups and healthcare providers, and support of the RI Department of Health, Brown University, Goldman Sachs 10KSB, and Social Enterprise Greenhouse, enable us to immediately begin to broaden our scope to learn more about the COVID-19 impact on underserved women and the provider community that supports them. We propose to expand our scope to: • conduct qualitative research activities to obtain specific input regarding the COVID-19 pandemic and economic crisis from pregnant and recently postpartum women and conduct interviews with the healthcare support network during the COVID-19 crisis; • expand the scope of the prototype to include specific content responding to feedback on needs related to COVID-19; and • systematically assess the impact of the prototype on key health outcome measures through a modest pilot study. We will focus on resilience as a key outcome and will measure related factors such as depression, anxiety, healthcare utilization, and postpartum experiences. These activities will provide a baseline for longitudinal data collection in Phase II; result in an even stronger program for postpartum care; and provide valuable data for future interventions and policies for this population.NARRATIVE STUDY DESCRIPTION Having a baby is a joyous time, but for most women, this joy is often combined with the challenges of returning to a prior state of wellbeing, concerns about the welfare of a new child, managing the reactions of other children, supporting other family members, and anxiety around returning to work. These stressors exist during a period of increased vulnerability physically and mentally. Women who are already marginalized due to race, ethnicity, or financial insecurity enter postpartum with a heightened level of stress with the joy and stress of a newborn added to existing burdens. The COVID-19 crisis adds yet another layer of uncertainty, fear, stress and isolation to this fragile pyramid of risks. This supplement aims to expand our original participant group of women who are in their third trimester or who have recently had a baby to learn about how the COVID-19 crisis has impacted them during this period of time. From this information, we can build a stronger program for postpartum care, and provide a broader picture of the challenges and needs of this population so that we can develop better tools, interventions and resources to assist them.