Adapting Current Strategies to Implement Evidence-Based Prevention Programs for Paraprofessional Home Visiting

Area of Science:

• Public Health
• Maternal and Child Health
• Health Disparities

Background:

• Low-income pregnant women face challenges in obesity prevention, breastfeeding duration, and postpartum depression.
• Evidence-based interventions (EBI) are effective but often require strict replication and fidelity, limiting their widespread implementation.
• A novel strategy is needed to adapt EBI for community-based implementation without compromising effectiveness.

Purpose of the Study:

• To describe a strategy for implementing evidence-based interventions (EBI) through community health workers without requiring strict fidelity.
• To assess the impact of mentor mother (MM) home visits on maternal obesity, breastfeeding duration, and depression.
• To evaluate the use of real-time data and data-informed supervision for iterative quality improvement.

Main Methods:

• Eight parents trained as mentor mothers (MM) conducted home visits with 101 low-income Latina and Korean pregnant women.
• MM were trained in 10 core practice elements common to child-focused EBIs.
• MM utilized mobile phones to report intervention content and skills, enabling data-informed supervision and iterative quality improvement.

Main Results:

• Increased frequency of MM focus on coping with depression was associated with lower BMI at 6 months.
• Breastfeeding duration was positively related to MM's focus on breastfeeding and parenting skills, and use of attending and relaxation techniques.
• Depression levels were correlated with the frequency of addressing depression by MM, but not specific practice elements.

Conclusions:

• A strategy adapting EBI for community health workers, utilizing data-informed supervision, can improve maternal and child health outcomes.
• This approach demonstrates iterative quality improvement in intervention delivery and links implementation processes to outcomes.
• This model offers a scalable and adaptable strategy for disseminating effective health interventions in diverse populations.