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.
Recognizing a one-time training is neither sufficient nor effective on its own, annual trainings will be followed by optional workshops to examine real world clinical and workplace scenarios shared by the group, as well as relevant topics identified through patient feedback.
Affinity groups are designed to be a place for people with similar backgrounds and identities to build a shared community that serves as a brave space for deeper learning and reflection.
Using the Crawford Bias Reduction Theory and Training (CBRT), a systematic approach for reducing biases, in a non-judgmental and positive environment, these trainings and groups will equip clinicians and staff with concrete skills to move from being reactive to bias, prejudice and racism, to being mindful and strategic in responses and actions.
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.
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.
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)
4. Support Staff (medical assistants, unit clerks, front desk)
5. Doulas and other community-based providers
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.
We know the significance of building meaningful relationships that can support the long and complex process of bringing new science to practice. Therefore, during Project HEAR we also identified and welcomed Change of HEART Champions Champions to lead by example.
- Tanise Branche (Obstetrician)
- Sarah Gibson (Lactation Consultant)
- Ashley Harvard (Resident)
- Robin Hendricks (Maternity nurse)
- Laura Igarabuza (Family Medicine Physician)
- Ronnell Laroda (Labor & Delivery Unit Clerk)
- Daphney Noel (Resident)
- Ellen Wolf (Labor & Delivery nurse)
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.
- Text messaging about diet, physical
activity, sleep, and infant feeding
- Remote blood pressure and weight
Building a Village
- Community doula care
- Infant feeding support
- Mental health assessment and
Building a Culture
- Trauma-informed, anti-racism training and follow-up process groups, along with affinity groups
- Patient-expert feedback about care experiences
- Timely response to elevated blood pressure alerts
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.