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CRAMER et al .
time restraints on the use of the PTP. The study lasted 15 months, and participants were in the study from enrollment to 36 weeks gestation. Intervention participants received usual prenatal care plus a smartphone preloaded with the PTP and weekly contact from the CHW. Participants could use the smartphone for personal use during the study. The PTP sent weekly automated text messages containing evidence‐based prenatal self‐care information and hyperlinks with more in‐depth information (Figure 1). Messaging was personalized by name, trimester, health risks (e.g., smoking, alcohol or substance use, and prepregnancy BMI for overweight/obesity), and preferred language (English or Spanish). Additionally, the participants had ac‐ cess to the platform to message the CHW via “chat” and to access prenatal topics of their choosing. The CHW was a Hispanic, bilingual (English and Spanish) female who was currently working as a paid CHW for one of the local hos‐ pital systems. One member of our research team who is a women’s health nurse practitioner (WHNP) along with a clinic partner devel‐ oped a CHW prenatal health coaching curriculum to supplement the CHW’s preexisting training as a CHW. The CHW contacted partic‐ ipants weekly via “texting” and/or telephone call, in addition to re‐ sponding to participant initiated “chat” through the platform. The weekly CHW contact might include a variety of topics based on the participant’s need including appointment reminders, social service assistance, to discuss weekly text messages or hyperlinks from the platform, and to answer general questions. Control participants received two visits from the CHW, usual prenatal care as decided by their health care provider, an informa‐ tional prenatal packet including information on pregnancy trimester,
healthy eating, and smoking cessation, and a local social service directory.
2.3 | Measures Information from participants was collected via two CHW home vis‐ its, the PTP, medical records, and hospital billing charge data. Our technology vendor, GoMo Health ™ , collected the mobile engagement data (hits, SMS, etc.). The project coordinator, a WHNP, gathered the collected data on birth outcomes from hospital delivery notes and financial information from hospital finance departments, both obtained through data transfer agreements between the university and the hospitals. Medical adherence data (e.g., clinic visits, missed appointments, and prenatal care information) was collected by the outpatient clinic nurses. The CHW collected PAM, CSQ, baseline data on health risks (smoking, obesity, substances, demographics) from participants during the home visit at enrollment and 36 weeks. Additionally, the CHW collected data necessary for individualization of the PTP intervention (i.e., language, trimester, risk factors) to be communicated to GoMo Health ™ for participants enrolled in the in‐ tervention group. Aim 1 study measures for feasibility included the subcategories of (1) patient satisfaction with intervention, (2) enrollment, (3) fidel‐ ity, and (4) data collection. Patient satisfaction data were collected using the Client Satisfaction Questionnaire (CSQ‐8). The CSQ‐8 is an 8‐question, self‐report measure designed to evaluate satisfac‐ tion and value of care. Scores range from 8 to 32, with higher scores indicating greater satisfaction. The CSQ‐8 has high‐internal consis‐ tency, good reliability, and validity and demonstrates a correlation
FIGURE 1 (a) Participants receive automated texts with hyperlinks for additional information. (b) Hyperlinks contain evidence‐based prenatal self‐care information. (c) The PTP includes the ability to chat with the CHW, information about the study, and access to the evidence‐based prenatal self‐care topics
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