Qualitative Process Evaluation of a Community Health Worker Intervention for Postpartum Hypertension at Grady Memorial Hospital Open Access
Paljug, Elianna (Spring 2023)
Abstract
Introduction: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the U.S., particularly among women of color. Women who had HDP during their pregnancy can reduce their chances of negative outcomes by continuing to remain connected to health care provision and maintaining lifestyle modifications related to BP management. Community Health Workers (CHWs) have been studied as effective modalities for supporting people with hypertension.
Objective: The objective of this work is to understand the experiences of CHWs and participants in a recently initiated project at Grady Memorial Hospital (GMH) that aims to facilitate CHWs supporting women who had HDP in managing their hypertension after delivery.
Methods: Key Informant Interviews (KIIS) were conducted with program leadership and In-Depth Interviews (IDIs) were conducted with 2 CHWs and 6 program participants, 3 for each CHW. Data were analyzed using descriptive, thematic, and comparative analysis, and used to form recommendations.
Results: Participants and CHWs described very positive experiences. Participants defined health as including various components of blood pressure (BP) management, understood the importance of BP management, and appreciated their CHWs for their personal qualities, consistent education, and multi-faceted support. Participants described successes and challenges in modifying their diet and stress management behaviors. Variation was found in practices of BP measurement, which often were cued to action by symptoms rather than a daily habit. Gaps within participants’ understandings of appropriate actions in a high BP emergency were thoroughly analyzed. CHWs were able to provide additional insight on the motivations and practices of BP management and measurement beyond the 6 participants interviewed. Programmatic processes such as recruitment, evaluation, and CHW training were described as mostly successful with some notable gaps. These findings were assembled into recommendations.
Conclusions: This project has shown the opportunities and challenges within a program aiming to use CHW to support patients with HDP manage their BP after delivery. The Health Belief Model (HBM) can be used to categorize findings and identify gaps for the program to address. Implementation of recommendations will strengthen this CHW program to be an effective model for supporting postpartum women who had HDP.
Table of Contents
CHAPTER 1: INTRODUCTION 1
CHAPTER 2: LITERATURE REVIEW 4
Postpartum Hypertension 4
General Introduction to the U.S. Maternal Health Crisis 4
Hypertensive Disorders of Pregnancy 7
Importance of Reducing Postpartum Hypertension 9
Risk Factors for Hypertensive Disorders of Pregnancy 10
Management for Postpartum Hypertension 11
Barriers to Postpartum Hypertension Management 14
Solutions to Prevent and Address Postpartum Hypertension 17
General Introduction to Existing Solutions and Gaps 17
Community Health Workers as providers of BP management care to postpartum women who had Hypertensive Disorders of Pregnancy 21
Project Overview: Enhanced Community Health Worker Support for Fourth Trimester and Beyond for Postpartum Women with HDP 23
CHAPTER 3: METHODS AND RESULTS 28
METHODS 28
Data Collection 28
Data Analysis 31
RESULTS 32
Enrollment 32
Participant Definitions of Health 33
BP Management – Overview 36
BP Management – Diet 38
BP Management – Stress Management 39
BP Measurement – Overview 41
BP Measurement – CHW assistance 48
High BP Emergencies 46
CHW Personal Qualities 49
Additional participant perceptions of the program 51
CHW Assistance with Participant Appointments 53
Additional Needs of Participants 53
CHW insights on BP measurement 54
CHW Opinions on Training and Support 58
Key needs of participants 58
CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATIONS 60
Analyzing Results through the Health Belief Model 60
CHW Performance as Cause of Program Success 65
Limitations 66
Next steps 67
Conclusion 67
Recommendations 68
Enrollment and Recruitment Recommendations 68
General BP Measurement and High BP Emergencies Recommendations 69
Food-related Recommendations 69
Other SDOH Recommendations 70
REFERENCES 71
APPENDIX 76
CHW Interview Guide 76
Participant Interview Guide 78
About this Master's Thesis
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