Premature Birth Clinical Trial
— EMBRACEOfficial title:
Comparing Approaches to Enhanced Prenatal Care to Improve Maternal and Child Health in Central CA
This is a randomized comparative effectiveness study of two forms of enhanced prenatal care among 657 Medi-Cal eligible pregnant individuals in Fresno, California. The goal is to see whether group prenatal care with wrap around services versus individual prenatal care supplemented by services covered by the California Department of Public Health Comprehensive Perinatal Services Program (CPSP) results in less depression and anxiety, and more respectful, more person-centered maternity care and lower rates of preterm birth.
Status | Recruiting |
Enrollment | 657 |
Est. completion date | November 1, 2024 |
Est. primary completion date | November 1, 2024 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | N/A and older |
Eligibility | Inclusion Criteria: - Between 8 and 24 weeks gestation at enrollment - Eligible for Medi-Cal (at or below 213% of the federal poverty level) - Speak English or Spanish Exclusion Criteria: - Unavailable to attend group prenatal care sessions - Not planning to continue prenatal care with site provider - Cannot legally consent to participate in the study |
Country | Name | City | State |
---|---|---|---|
United States | Central Valley Health Policy Institute | Fresno | California |
United States | UCSF | San Francisco | California |
Lead Sponsor | Collaborator |
---|---|
University of California, San Francisco | California State University, Fresno Foundation, Patient-Centered Outcomes Research Institute |
United States,
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Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092. — View Citation
Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, Jolicoeur G; CCinBC Steering Council. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM Popul Health. 2017 Jan 19;3:201-210. doi: 10.1016/j.ssmph.2017.01.005. eCollection 2017 Dec. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Changes in Patient Health Questionnaire (PHQ-9) Score | Changes in depressive symptom severity from baseline to postpartum. Assessed using the Patient Health Questionnaire (PHQ-9), administered in-person at baseline and during telephone interview at three months postpartum. Total score ranges from 0-27 with higher scores indicating more severe depression. | Collected from study enrollment to three months postpartum | |
Primary | Person-centered prenatal care | This outcome focuses on the extent to which the participants feels their prenatal care was person centered.
The title of the measure is Person Centered Prenatal Care (primary). This measurement tool is a questionnaire that includes series of items that were developed in collaboration with community members to measure their experience of care. In addition to the overall score, the scale includes three subscales identified as important by community members: dignity and respect, communication and autonomy, and responsive and supportive care. The measures have been validated in several languages. The total scores range from 0-100 with higher scores indicating the receipt of more person centered care. |
Collected during third trimester | |
Primary | Preterm birth | Whether the participant had a baby born less than 37 weeks gestation, as noted in the participant's medical record. | 0-12 weeks after delivery | |
Secondary | Changes in anxiety symptom severity | Changes in anxiety symptom severity from baseline to postpartum. Assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale, administered in-person at baseline and during telephone interview at three months postpartum.
The total scores range from 0-21 with higher scores indicating more severe anxiety. |
Collected from study enrollment to three months postpartum | |
Secondary | Perceptions of respectful/disrespectful maternity care | Extent to which the participant feels that the maternity care they received was respectful. Assessed using the Mothers on Respect Index (MORi), administered during telephone interview or in-person at third trimester and three months postpartum.
The total scores range from 14-84 with higher scores indicating a higher level of respect. |
Collected at three months postpartum | |
Secondary | Satisfaction with prenatal care | Extent to which the participant feels satisfied with the prenatal care they received. Assessed using the Prenatal Care Satisfaction Scale, administered during telephone interview or in-person interview at third trimester and three months postpartum.
The total scores range from 0-100 with higher scores indicating higher levels of satisfaction. |
Collected during third trimester and at three months postpartum | |
Secondary | Gestational age at delivery | The gestation age at which the baby was born (number of weeks), as noted in the participant's medical record. | 0-12 weeks after delivery | |
Secondary | Person Centered Maternity Care as measured at 3 months postpartum. | Extent to which birthing person feels their prenatal and birthing experience was person centered, as measured by the Person-Centered Maternity Care scale.
This measure focuses on the extent to which the participants feels their prenatal and maternity/birthing care was person centered. The title of the measure is Person Centered Maternity Care. This measurement tool is a questionnaire that includes series of items that were developed in collaboration with community members to measure their experience of care. In addition to the overall score, the scale includes three subscales identified as important by community members: dignity and respect, communication and autonomy, and responsive and supportive care. The measures have been validated in several languages. The total scores range from 0-100 with higher scores indicating the receipt of more person centered care. |
3 months postpartum |
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