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. Blackwomen are 3-4 times more likely than white women to experience maternal mortality. In the US, 1 in 4 womendo not have a timely postpartum visit, and adherence is even lower for women on Medicaid managed careplans. Our Parent Grant (R43MD014923) was funded to develop a program that educates and supportsmothers in the 'fourth trimester', to address the physical, cultural, and knowledge barriers to quality postpartumcare. 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 addfeatures to the tool we are building to address immediate concerns and needs related to this crisis. Thechallenges of the current pandemic will have a lasting impact for minority and economically at-risk populationsbecause fundamental health disparities persist, further inhibiting already limited access to timely andappropriate 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 ensuingeconomic 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 populationand are most at risk of losing their businesses during times of economic instability. Research focused on theconcerns, needs, and health of underserved women, and the development of digital tools to reduce gaps incare which specifically address barriers exacerbated by COVID-19, are essential to protect the health ofmothers and their babies. Our strong relationships with community groups and healthcare providers, andsupport of the RI Department of Health, Brown University, Goldman Sachs 10KSB, and Social EnterpriseGreenhouse, enable us to immediately begin to broaden our scope to learn more about the COVID-19 impacton 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 economiccrisis from pregnant and recently postpartum women and conduct interviews with the healthcare supportnetwork during the COVID-19 crisis; • expand the scope of the prototype to include specific content respondingto feedback on needs related to COVID-19; and • systematically assess the impact of the prototype on keyhealth outcome measures through a modest pilot study. We will focus on resilience as a key outcome and willmeasure 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 strongerprogram for postpartum care; and provide valuable data for future interventions and policies for this population.