Qualitative Process Evaluation of a Community Health Worker Intervention for Postpartum Hypertension at Grady Memorial Hospital Restricted; Files Only

Paljug, Elianna (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/7m01bm94b?locale=pt-BR
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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

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