Impact of a Community Health Worker (CHW) Home Visiting Intervention on Any and Adequate Prenatal Care Among Ethno-Racially Diverse Pregnant Women of the US Southwest

Abstract

Objectives Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona’s Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women. Methods We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006–2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary. Results Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02–1.50) and adequate (OR 1.08, 95%CI 1.01–1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07–4.60), primipara women (OR 1.64, 95%CI 1.13–2.38), teens (OR 1.58, 95%CI 1.02–2.45), women in rural border counties (OR 1.45, 95%CI 1.05–1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11–1.55), women in rural border counties (OR 1.18, 95%CI 1.05–1.33), primipara women (OR 1.18, 95%CI 1.05–1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27). Conclusions for Practice: A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.

Community and Systems Contributors and Strategies to Reduce Racial Inequities in Maternal Health in the Deep South: Provider Perspectives

“… 34 In-home visiting programs with community health workers or nurses have effectively improved prenatal care utilization and birth outcomes such as preterm birth among economically disadvantaged and ethnically diverse women. 35–37 The need for policy changes to increase access and affordability of maternity care was highlighted by our participants and has been emphasized by others. 25 , 38 Additional strategies to reduce inequities from the literature include prioritizing implementation research and promoting opportunities for providers to have meaningful discussions with patients outside of the clinical setting.…”

Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods

“…Our study makes a contribution to previous studies by highlighting neighborhood conditions in HV interventions and addressing the challenge of increasing HV utilization among birthing people of color in disadvantaged communities. [8][9][10] Compared with previous CHW-informed HV studies focusing on individual risk factors and birth outcomes, 20,21 we expanded the analyses to neighborhood segregation and examined program engagement, an important step to achieve program effectiveness on birth outcomes. Compared with previous literature on neighborhood determinants of HV program engagement, [13][14][15] we took a step further by evaluating how CHW-delivered HV programs can facilitate program outreach to segregated neighborhoods and provided operational a Neighborhood segregation was measured with year-specific ICE using both income and race/ethnicity at the census tract level, which was averaged across years and divided into quintiles representing from the most segregated neighborhoods with concentrated deprivation (most deprived, Q1) to the most segregated neighborhoods with concentrated privilege (least deprived, Q5).…”

“…Policymakers are increasingly calling for culturally responsive and community-driven approaches to reduce perinatal racial inequities 7,17-19. Community health worker (CHW)-delivered HV programs are an effective approach to provide outreach, support, and services to birthing people with barriers to care 20-22. CHWs are frontline, race, ethnicity, and/or language-concordant public health workers 17.…”

“…As trusted members of the community who share similar experiences and/or have an unusually close understanding of the community served, CHWs empower birthing people through intensive and long-term relationships, address complex health and psychosocial needs, and help with service navigation in a fragmented health care system 22-24. Previous studies suggest that CHWs are effective in engaging people of color with multiple risk factors (eg, less than a high school diploma and with preexisting health conditions) 7,20,21. However, these risk factors are at the individual level, and we know little about whether CHWs can facilitate program outreach and increase HV engagement in segregated neighborhoods with concentrated deprivation.…”

Hypertensive Disorders of Pregnancy

“…Involvement of a CHW increased prenatal care attendance significantly in a historically marginalized community of Latina and Native American individuals and mostly publicly insured cohort. 64 Though not a pregnancy-related study, CHW and telehealth were combined in the DREAM-GLOBAL study. 65 A Canadian Indigenous and Tanzanian sample of middle-aged men and women involved a CHW to help volunteers measure BP on a centrally located device in a community health center, where they submitted measurements to a central server.…”