Change of HEART (Here for Equity, Advocacy, Reflection and Transformation) is a community-engaged research study with the overarching goal of making meaningful and sustainable improvements for Temple’s Black birthing people and their short- and long-term cardiovascular health. As part of this research, the Change of HEART study team is sponsoring anti-racism trainings, workshops and groups designed for Temple Health clinicians and staff that are involved in the care of Black birthing people and their infants throughout pregnancy and the first year postpartum.

Join us!
Are you a clinician or staff member at Temple Health who works with pregnant or postpartum patients and their babies?
Why is this research being done?

Heart disease (e.g., heart attack, stroke) is the leading cause of maternal death in the United States, responsible for nearly 50 percent of pregnancy-related deaths among Black women and birthing people, three times the rate of white women, and is largely preventable. The overarching goal of this research is to make meaningful and sustainable improvements for Temple’s Black birthing people and their short and long-term cardiovascular health. The purpose of this research is to lower blood pressure and encourage healthy body weight in Black women and birthing people who receive care at Temple with the goal of trying to improve maternal heart health.

Who is part of our research team?

The Change of HEART (Here for Equity, Advocacy, Reflection and Transformation) Program is a collaboration among community providers and thought leaders from Philadelphia’s Maternal Wellness Village, clinicians and staff from Temple Health, including Temple Obstetricians Dr. Gail Herrine and Dr. Wadia Mulla as study co-investigators, and researchers from Temple University’s Program for Maternal Health Equity. The full study investigative team also includes academics and researchers from other institutions in Philadelphia (Drexel and Jefferson) and beyond (Duke and Columbia) as well as the Change of HEART Community Advisory Board (CAB) with its 9 members representing Black parents, doulas, nurses, midwives, lactation consultants and physicians who offer additional input and wisdom from their lived and professional experiences.

Our Process
How is this research process different from other studies?

At the core of our approach is the recognition that authentic systems-level change to improve maternal health equity is most effective when it centers partnerships with impacted communities, honors community knowledge, and equalizes power between academics and community members. However, we also recognize that health equity research often does not elicit and address the practical needs of the stakeholders responsible for implementing health care delivery interventions at institutions working to achieve better outcomes. Therefore, our inclusive approach to this research spans a wide range of stakeholder groups in recognition that all voices must be heard, and all experiences must be valued in order to effectively and respectfully implement our study.

In the first phase of the study, Project HEAR (Here to Engage, Adapt and Refine), we held 3 rounds of focus groups for each of 6 stakeholder team to inform the adaptation and refinement of the interventions and our plans for implementation:

1. Faculty (attending physicians and midwives)
2. Residents
3. Nurses

4. Support Staff (medical assistants, unit clerks, front desk)
5. Doulas and other community-based providers
6. Patients

However, over the past year we additionally recognized the need to more deeply connect with health system leadership, social work staff, patient experience faculty and staff as well as the LKSOM’s Office of Health Equity, Diversity and Inclusion to more comprehensively get the input we need throughout the duration of the Change of HEART Study.

 

Our Design
How is this research design different from other studies?
Intervening at the individual, interpersonal and institutional levels

There has been so much attention in recent years to disparities in cardiovascular disease risk factors for Black birthing people and yet the needle hasn’t moved in the direction of equity. We believe that part of what is missing in efforts to date are multilevel interventions that emerge from the lived experience and expertise of Black women and birthing people that provide support from early pregnancy through the end of the first postpartum year – interventions that address individual lifestyle behaviors in the context of resilience, family and relationships, along with community-level factors and institutional barriers, including structural racism. Very few multilevel treatments exist, which is why we are addressing this with the Change of HEART study, which will compare the effectiveness of two 18 month multi-level interventions to reduce cardiovascular disease risk factors.

Individual:
Building Skills
  • Text messaging about diet, physical
    activity, sleep, and infant feeding
  • Remote blood pressure and weight
    monitoring
Interpersonal:
Building a Village
  • Community doula care
  • Infant feeding support
  • Mental health assessment and
    treatment
Institutional:
Building a Culture

Both intervention approaches provide tips and strategies for a healthy diet and physical activity via text messages along with home blood pressure and body weight self-monitoring (using a blood pressure monitoring cuff and a scale provided at enrollment). The two approaches also both include offering action-oriented anti-racism trainings to Temple health providers and staff. However, only one of the approaches being studied adds support through community doula care, mental health services, and infant feeding support from Maternal Wellness Village’s community-based providers.

We want to learn if these additional supports from providers with shared lived experience lead to lower blood pressure, lower body weight and a greater number of patients reporting experiences of respectful maternity care.

 

What outcomes are being studied?
The primary outcomes of the Change of HEART study are changes in maternal blood pressure and body weight at six weeks and one year after giving birth. The team will also evaluate how well the treatments are implemented and able to reach patients, be adopted into practice consistently, and lead to healthcare provider and patient satisfaction.The team will also analyze outcomes that patient partners anxiety disorders (e.g., postpartum depression), emotional and informational support, stress, and experiences of respectful maternity care. In addition, the study team will look at clinical outcomes including if and for how long patients breastfeed, hypertensive disorders of pregnancy, how the patient gave birth (e.g., vaginal or cesarean), baby’s birth weight, and how many weeks pregnant birthing people were at the time of birth.
Who can this research help?
This study will increase Black mothers’ and birthing people’s understanding of the many influences on their heart health. Findings from this study will help Black women and birthing people with obesity and/or high blood pressure make informed decisions about the use of community doulas, lactation professionals, and psychotherapists as part of their care to reduce risks for heart disease during pregnancy or in the first year after their baby is born. Results may also strengthen health systems’ commitment to anti-racism training as part of their efforts to provide quality health care for Black pregnant and postpartum people. And further, this research may provide evidence to insurance companies that coverage of this study’s package of support is needed.
Interested in referring a patient
to Change of Heart?
Want to find out more? Contact Us