ABSTRACT
Objective: To evaluate the impact of a community-based intervention on perinatal mental health in an urban population during the COVID-19 pandemic Study Design: We performed a prospective cohort study of pregnant and postpartum individuals referred to a new community-based intervention, Helping Us Grow Stronger (HUGS/Abrazos). Participants received four virtual acute behavioral health sessions from a cognitive behavioral therapy (CBT) and trauma-informed care trained social worker, four resource navigation visits with a community health worker, and a care package. Participants completed validated survey instruments assessing mood, anxiety, stress, food insecurity, experience of discrimination, and program satisfaction before and after program completion. Result(s): 103 participants (Table) completed surveys before and after the program. In this urban obstetric population, there were high rates of food insecurity (54%), experiences of discrimination (61%), and COVID-19 infection in pregnancy (62%). Program satisfaction was high (Table). The program was associated with improvement in Edinburgh Postnatal Depression (EPDS) scores (mean 8.3 pre-HUGS vs 6.7 +-5.6 post, p=0.001), with significant reduction in those screened positive for depression (46/103 pre- vs 31/103 post, p< 0.001);improvement in Perceived Stress Scale (PSS) scores (mean 15.4 +- 8.0 (SD) pre vs 13.5+- 7.1 post, p=0.003) with significant reduction in those with moderate or high stress (56/103 pre vs 49/103 post, p< 0.001);and reduction in those screened positive on the PROMIS anxiety scale (46/103 pre vs 40/103 post, p< 0.001). In stratified analyses (Figure), food insecurity, COVID-19 in pregnancy, and experiences of discrimination were associated with improvement in PSS scores and PROMIS anxiety score. Conclusion(s): In a diverse urban cohort, this novel community-based intervention led to improvement in depression, perceived stress, and anxiety, particularly for those with toxic life stressors in pregnancy including food insecurity, discrimination, and COVID-19 infection. [Formula presented] [Formula presented] Copyright © 2022
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Even though they face a higher risk of COVID-19-related morbidity and mortality, racial and ethnic minorities in the Greater Boston area have had less access to COVID-19 testing and vaccinations. DESCRIPTION OF PROGRAM/INTERVENTION: We implemented a novel, community-based mobile health unit program by repurposing transportation vans with COVID-19 testing equipment, preventive hygiene kits, and mRNA vaccines. Our goal was to expand testing and vaccine availability in highly affected communities in the Greater Boston area. We used a “double equity” model by hiring workers from a local transportation company whose staff were at risk of unemployment. The vans were staffed with racially/ ethnically diverse and multilingual staff, including members of the target communities themselves. We incorporated a system of “trusted messengers” to answer questions about COVID-19 and in particular, vaccination from the community. We implemented this program with crucial input from community-based organizations and municipal public health departments. Van location sites were guided by community partners, in some cases incorporating SARS-CoV-2 wastewater surveillance data to meet rapidly changing community needs. MEASURES OF SUCCESS: Our goals were to (1) demonstrate the feasibility of a COVID-19 testing program guided by community partnerships and SARS-CoV-2 wastewater surveillance data;(2) improve access to COVID-19 testing in underserved communities;and (3) improve access to COVID-19 vaccination among racial/ethnic minorities. We collected ongoing feedback (e.g. through the local community advisory groups etc) on the mobile health program from community partners, patients, and staff. We compared sociodemographic characteristics of mobile health participants with the general population of the state of Massachusetts and the population of the target communities. FINDINGS TO DATE: From January 2021 - January 2022, our mobile health units have tested greater than 4500 persons in predominantly low socioeconomic communities that have been highly impacted by the pandemic. From May 2021 - January 2022, we vaccinated 5480 persons in these communities. An analysis of our program from January 2021 - January 2022 demonstrated that mobile health unit participants receiving COVID-19 vaccines were significantly more likely to be non-White and Hispanic compared with the general vaccinated population of the state of Massachusetts and of the target communities, and these findings were statistically significant. We also found that the mobile health units vaccinated more youth and adolescents in the target community compared with the general state vaccination data. KEY LESSONS FOR DISSEMINATION: Delivery of preventive COVID19 care via mobile health units is feasible and associated with high usage from affected communities when implemented with high stakeholder engagement and expertise from local public health departments. Employing diverse, multilingual, and well-trained healthcare staff as trusted messengers likely improved COVID-19 vaccine uptake in this population.
ABSTRACT
Background: Childhood obesity is highly prevalent in the US and disproportionately impacts minorities;these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMI) that have been evaluated among low-income minority populations is needed. Connect for Healthy Weight, a package co-developed by the AAP and MGH, helps federally qualified health centers (FQHC) establish multidisciplinary healthy weight clinics based on previous effective RCTs. We sought to identify the determinants to successful adoption of Connect for Healthy Weight in pre-and post-implementation sites. Methods: We interviewed 19 stakeholders, 10 from two FQHCs in MS where Connect for Healthy Weight will be piloted and 9 from health centers that have previously implemented it. Separate interview guides informed by the Consolidated Framework for Implementation Research were developed. Qualitative data analysis was conducted using the immersion-crystallization method. Results: In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social determinants of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from post-implementation sites;adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described. Conclusions: Understanding the determinants to adoption of an evidence-based PWMI allows for necessary adaptations to be made to facilitate adoption and nationwide dissemination.