Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Partner-Level Intervention, Technology-Based Support,

Intervention Description: One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals have been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. Couples allocated to the eHealth study condition (SC1) were provided with access to a previously created, publicly available eHealth breastfeeding co-parenting website, which they could access independently throughout the perinatal period. Couples allocated to the Available Resources Only condition were informed that they could assess breastfeeding resources generally available in the community. Among couples randomized to the SC1, information was collected regarding participation in the virtual meeting and use of the eHealth resource which was assessed at all follow-up time points.

Intervention Results: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% ‘exclusive’ 6 months) and (SC1 71% and SC2 78% ‘any’ 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly.

Conclusion: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

Study Design: RCT

Setting: Online

Population of Focus: Expectant women planning to breastfeed for the first time and their co-parents

Sample Size: 113 expectant women and 104 of their co-parents

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Online Games

Intervention Description: The proliferation of the video game era has increased sedentary behaviours among children and adolescents. Contemporary interventions involve the use of video games to introduce fruit and vegetable (F&V) consumption among children and adolescents. A comprehensive list of licenced video games (n = 671) released for the Nintendo Entertainment System (NES) console were reviewed for thematic content and qualitative characteristics of the game's activity relevant to F&V. Seventy-five video games were included in the study sample and categorised by release year, prevalence of F&V, and thematic content.

Intervention Results: Mild associations were found comparing release year to F&V totals (r = 0.21) and release year to theme (r = 0.19). F&V themes embedded within classic video games could serve as health-promoting lessons for forthcoming video games. Future games produced by the video gaming industry should continue to focus on nutrition-embedded messages promoting F&V.

Conclusion: Video game development and marketing could be an avenue that incorporates healthy nutrition themes.

Study Design: The proliferation of the video game era has increased sedentary behaviours among children and adolescents. Contemporary interventions involve the use of video games to introduce fruit and vegetable (F&V) consumption among children and adolescents. A comprehensive list of licenced video games (n = 671) released for the Nintendo Entertainment System (NES) console were reviewed for thematic content and qualitative characteristics of the game's activity relevant to F&V. Seventy-five video games were included in the study sample and categorised by release year, prevalence of F&V, and thematic content.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: This was a retrospective cross-sectional study of nulliparous and multiparous pregnant women at a large urban tertiary care center. On admission, patients are routinely asked if they participated in a childbirth education (CBE) class or have a birth plan. This information is charted by nurses and available for abstraction from the electronic medical record. Clinical data abstraction was performed to obtain self-reported attendance at a CBE class or to identify the presence of a written birth plan. A subset analysis was performed on nulliparous women only (n = 9,168).

Intervention Results: In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls.

Conclusion: Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.

Setting: Large urban tertiary care center

Population of Focus: Women with singleton pregnancy >24 weeks gestation

Intervention Components (click on component to see a list of all articles that use that intervention): Community-Based Group Education, , PATIENT_CONSUMER

Intervention Description: This study focused on this population in a quantitative, randomized controlled trial using a low-cost, brief educational intervention, a Safety Baby Shower (SBS).

Intervention Results: Comparing self-report, safe sleep knowledge, attitudes, beliefs, and intent (KABI) to act scores across the two groups found intervention dyads to have more positive views on all four constructs than controls. Specifically, intervention dyad young mothers were significantly more likely to have positive beliefs about safe sleep and were more likely to report intent to practice infant safe sleep than control young mothers. Intervention dyad young mothers also had higher self-efficacy related to infant safety and more positive attitudes about safe sleep practices than control young mothers. Observations at a home visit conducted after delivery found no differences in the safe sleep practices by intervention status. Participant report of behaviors at the home visit also showed no differences in the use of safe position between the intervention and control groups.

Conclusion: It appears that even when young mothers gain knowledge and self-efficacy, they have difficulty implementing this knowledge. In practice, this suggests that exploring barriers prenatally with this population and offering suggestions to overcome them may be indicated.

Intervention Components (click on component to see a list of all articles that use that intervention): Education/Training (caregiver), Enabling Services, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit.

Intervention Results: The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers’ satisfaction increased.

Conclusion: We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers’ satisfaction increased.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: This randomized controlled trial assigned women to receive either an organized, consistent program of intensive dietary and lifestyle counseling or routine prenatal care. The control group received routine prenatal care per American College of Obstetricians and Gynecologists standards and was given a prenatal booklet that included advice on diet and exercise during pregnancy. The intervention group underwent a complete history and physical examination with specific attention paid to prepregnancy weight, current weight, height, and BMI. At the initial visit, the study group met with a registered dietician to receive a standardized counseling session, including information on pregnancy-specific dietary and lifestyle choices. Patients were instructed to engage in moderate-intensity exercise at least three times per week and preferably five times per week. They also received information on the appropriate weight gain during pregnancy using the IOM guidelines. Participants' weight was measured during routine appointments, and if it was not within IOM guidelines they were advised to increase or decrease their dietary intake and increase or decrease exercise.

Intervention Results: A total of 100 women were randomized to the study (lifestyle counseling 57, routine prenatal care 43). Baseline demographic characteristics were similar between the study groups. The lifestyle counseling group gained significantly less weight than did the routine prenatal care group (28.7+/-12.5 lb compared with 35.6+/-15.5 lb, P=.01). The routine prenatal care group had significantly more cesarean deliveries due to "failure to progress" (routine prenatal care 58.3% compared with lifestyle counseling 25.0%, P=.02). Across groups, patients who were not adherent to the IOM guidelines had significantly heavier neonates (adherent 3,203.2+/-427.2 g compared with not adherent 3,517.4+/-572.4 g, P<.01). Nulliparous women gained significantly more weight than did parous women (36.5+/-14.5 lb compared with 27.7+/-12.7 lb, P<.01). The most predictive factor of IOM adherence was having a normal prepregnancy body mass index. No statistically significant differences were noted between the groups in adherence to IOM guidelines, rate of cesarean delivery, preeclampsia, GDM, operative vaginal delivery, or vaginal lacerations.

Conclusion: An organized, consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy.

Setting: Carolinas Medical Center, Charlotte, North Carolina

Population of Focus: Obese nulliparous and multiparous pregnant women with singleton gestrations

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Provider Training/Education, Patient-Centered Medical Home, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children’s Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration’s six key principles of a trauma-informed approach.

Intervention Results: Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02).

Conclusion: Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Educational Material, Telephone Support, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: In efforts to improve breeastfeeding rates, WIC established the Breastfeeding peer Counselor program (BFPC) model to improve breastfeeding rates among participants. The Upstate New York WIC BFPC program (UNYWIC BFPC) began with volunteers who provided support to WIC participants referred to BFPC services. The BFPCs completed Loving Support training. BFPC contacts included telephone, in-person (WIC clinic or home), and mailings.

Intervention Results: Mothers who accepted BFPC referrals and had at least 1 phone conversation or in-person contact had a significant 35% to 164% increased odds of positive BF outcomes. Mailings did not significantly improve outcomes.

Conclusion: The Special Supplemental Nutrition Program for Women, Infants, and Children may need to identify barriers to BF duration and implement interventions in communities with low BF rates. Future studies may benefit from evaluating the impact of combined in-person support and phone contacts during the prenatal and postpartum periods on BF outcomes.

Study Design: Secondary data analysis

Setting: The Upstate New York WIC Breastfeeding Peer Counselor program

Population of Focus: WIC-enrolled mothers with live singleton births who accepted a Breastfeeding Peer Counselor program referral

Sample Size: 2,149 mothers

Age Range: 5 day old infants (prenatal and postnatal contact with mothers)

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Continuity of Care (Caseload), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: Using semistructured focus groups and interviews, we evaluated practices, messaging, and the prospect of integrating and coordinating care.

Intervention Results: Stakeholders supported sharing health assessment data and integrating health services as strategies to enhance the quality of care, but were concerned about security and confidentiality.

Conclusion: Overall, integrated, coordinated care was perceived to be an acceptable strategy to facilitate consistent, preventive education and improve patient-centeredness.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: A randomized controlled trial was conducted with 290 healthy pregnant Caucasian (Spanish) women with a singleton gestation who were randomly assigned to either an exercise (n=138) or a control (n=152) group. The physical conditioning exercise included a total of three 40-45 minute sessions per week, beginning at the start of the pregnancy (weeks 6–9) until the end of the third trimester (weeks 38–39). Each session included a 25-minute core portion that was preceded and followed by a gradual warm-up and cool-down period, both of 7–8 minutes in duration and consisting of walking and light, static stretching (to avoid any muscle pains) of most muscle groups (upper and lower limbs, neck and trunk muscles).

Intervention Results: The percentage of cesarean and instrumental deliveries in the exercise group were lower than in the control group (15.9%, n = 22; 11.6%, n = 16 vs. 23%, n = 35; 19.1%, n = 29, respectively; p = 0.03). The overall health status of the newborn as well as other pregnancy outcomes was unaffected.

Conclusion: Based on these results, a supervised program of moderate-intensity exercise performed throughout pregnancy was associated with a reduction in the rate of cesarean, instrumental deliveries and can be recommended for healthy women in pregnancy.

Setting: University Hospital in Madrid, Spain

Population of Focus: Low risk Caucasian (Spanish) women with singleton gestations

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Expert Support (Provider), PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We implemented the newborn cohort clinic (NCC) to explore the application of the patient-centered medical home (PCMH) model for infants and children with SCD from birth to age 3 years in 2011.

Intervention Results: A total of 112 patients have been managed in the NCC. All patients received penicillin prophylaxis, while 70% and 73% of patients, respectively, received the 23-valent pneumococcal vaccine and an initial transcranial Doppler by age 36 months. Most (92 of 112) of the subjects utilized the emergency department (569 encounters), with 86% of encounters for fever or other sickle cell–related complications. The majority of parents indicated satisfaction with the clinic, with 71% saying clinic providers always or usually spent enough time with their child, listened carefully to them (81%) and were sensitive to family values and customs (77%).

Conclusion: A comprehensive sickle cell clinic as a component of a PCMH is feasible and can achieve high levels of preventative care. Parents are largely satisfied with this model of care.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: To evaluate whether a postpartum text message–based communication platform improves breastfeeding rates.

Intervention Results: From January 2020 to January 2021, 300 patients were enrolled and 216 were randomized as follows: 110 to control and 106 to intervention. In the cohort, 52.8% were Black, 45.4% had public insurance, and 46.3% were nulliparous. There were no differences in demographic, delivery, or postpartum characteristics between groups. Among the 185 patients (85.6%) with data available for the primary outcome, there was no difference in breastfeeding exclusivity by treatment group (intervention 48.4% vs usual care 41.3%, P=.33). When stratified by race, Black patients in the intervention arm had 2.6 times higher odds of exclusively breastfeeding at 6 weeks postpartum compared with Black patients in the control arm (39.5% vs 20.0%, odds ratio 2.62, 95% CI 1.04–6.59). Enrollment in the intervention arm decreased the Black–non-Black disparity in the primary outcome (20.0% vs 66.7%, P<.001in usual care arm vs 39.5% vs 56.0%, P=.11 in intervention arm). There were no differences in other secondary outcomes.

Conclusion: A text message–based communication platform was not associated with breastfeeding exclusivity at 6 weeks postpartum compared with usual care.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Reporting & Response System, CLASSROOM_SCHOOL, PATIENT_CONSUMER, Feedback

Intervention Description: This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.

Intervention Results: The likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.

Conclusion: The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: To determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations.

Intervention Results: Nine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12).

Conclusion: In this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: This study investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences. Qualitativ, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group.

Intervention Results: A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership.

Conclusion: The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration.

Study Design: Qualitative study (exploratory, deductive approach)

Setting: Social media platform: Private Facebook group

Population of Focus: Women who were members of a private Facebook group

Sample Size: 8 women

Intervention Components (click on component to see a list of all articles that use that intervention): Telelactation, Technology-Based Support, Telephone Support, PATIENT_CONSUMER

Intervention Description: To identify facilitators and barriers of two modes of tele-health service utilization and to compare the differences between two modes of providing tele-lactation services on breastfeeding knowledge, breastfeeding intention, perceived social support, and 3-month breastfeeding continuation behavior.

Intervention Results: No significant difference in demographic characteristics across groups was found. At 3 months after discharge, both groups reported continued breastfeeding (telephone-only: n = 17, 81%; audio-visual: n = 18, 90%) with no significant difference between the two groups (p = .663). Additionally, no group differences were found for breastfeeding knowledge or perceived social support. Overall, participants reported positive experiences with tele-lactation, emphasizing the convenience, accessibility, education, and support provided.

Conclusion: We found that both telephone-only and audio-visual delivery of tele-lactation services were equally effective. Both methods of tele-lactation services should be considered by health care providers to encourage and sustain breastfeeding behavior in mothers.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, STATE, Policy/Guideline (State)

Intervention Description: In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001–December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

Intervention Results: Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.

Conclusion: Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.

Setting: Hospitals in Arkansas

Population of Focus: Medicaid-covered women in Arkansas

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Consultation (Parent/Family), Access to Provider through Hotline, PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines.

Intervention Results: A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Conclusion: Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Educational Material, PATIENT_CONSUMER

Intervention Description: 1) Determine if using the Mother’s Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app.

Intervention Results: There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study.

Conclusion: MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: To determine effectiveness of text/telephone outreach messages, with and without coronavirus disease 2019 (COVID-19) vaccine information. Study design

Intervention Results: We randomized 1235 adolescents (mean age, 14 ± 1.5 years; 51.6% male; 76.7% Black; 4.1% Hispanic/Latinx; 88.3% publicly insured). The standard message group had higher odds of scheduling an adolescent well-care visit compared with the control group (OR, 2.07; 95% CI, 1.21-3.52) and COVID-19 vaccine message group (OR, 1.66; 95% CI, 1.00-2.74). The odds of completing an adolescent well-care visit did not differ significantly (standard message group vs control group; OR, 1.35; 95% CI, 0.88-2.06; COVID-19 vaccine message group vs control group, OR, 1.33; 95% CI, 0.87-2.03). In per-protocol analyses, adolescents in the standard message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48; 95% CI, 1.05-5.86).

Conclusion: Outreach messages were minimally effective. Efforts are needed to address widening disparities.

Intervention Components (click on component to see a list of all articles that use that intervention): Baby Friendly Hospital Initiative, PATIENT_CONSUMER, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider)

Intervention Description: The aims of Mississippi Communities and Hospitals Advancing Maternity Practices (CHAMPS) were to (1) increase breastfeeding initiation and exclusivity and (2) decrease racial disparities in breastfeeding by increasing the number of Baby-Friendly hospitals in the state from 2014 to 2020.

Intervention Results: Between 2014 and 2020, the number of Baby-Friendly hospitals in Mississippi rose from 0 to 22. Breastfeeding initiation in the hospitals increased from 56% to 66% (P < .05), and the disparity between Black and White dyads decreased by 17 percentage points, an average of 0.176 percentage points each month (95% confidence interval: −0.060 to −0.292). Exclusivity increased from 26% to 37% (P < .05). Skin-to-skin and rooming-in rates increased significantly for all dyads: 31% to 91% (P < .01) for skin-to-skin after vaginal birth, 20% to 86% (P < .01) for skin-to-skin after cesarean delivery, and 19% to 86% (P < .01) for rooming-in.

Conclusion: Over the course of the CHAMPS program, there were significant increases in breastfeeding initiation and exclusivity, and decreases in racial inequities in breastfeeding initiation.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Transition Assistance, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: Our aim was to assess the effect of a communication technology enhanced transition coordinator intervention compared with usual care on clinic attendance among transitioning youth with type 1 diabetes.

Intervention Results: There were no baseline differences in age, sex, HbA1c and number of follow-up visits, emergency department visits and diabetic ketoacidosis admissions in the 1 year prior to transition between the usual care (n = 101) and intervention (n = 102) groups. In the year following transfer, 47.1% in the usual care group vs 11.9% in the intervention group did not attend any outpatient diabetes appointments (p < 0.01). There were no differences in glycaemic control or diabetic ketoacidosis post transfer.

Conclusion: Our intervention was successful in improving clinic attendance among transitioning youth with type 1 diabetes. Importantly, this programme used simple, readily accessible communication technologies, which increases the sustainability and transferability of this strategy.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Expert Support (Provider), Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program.

Intervention Results: All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact.

Conclusion: Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Administration/Practice Management, Quality Improvement, HOSPITAL, PATIENT_CONSUMER, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder

Intervention Description: Researchers implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series.

Intervention Results: In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline.

Conclusion: We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.

Setting: Pediatric and community clinics

Population of Focus: Pediatricians and staff

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: A standardized antenatal class was developed in accordance with World Health Organization and Italian Ministry of Health indications to evaluate whether women who attend the class during pregnancy have a lower cesarean section rate. After recruitment, 1155 women (603 primiparous) were included in the study (286 participants in antenatal class and 869 non-participants).

Intervention Results: Non-participants of antenatal class showed a higher rate of cesarean section than those who participated (56.2% vs 23.1%; relative risk [RR] = 2.43; 95% confidence interval [CI] 1.95-3.03; P < .0001), as well as after adjustment for other variables. This difference was stronger in 1 hospital (RR = 2.88; 95% CI 2.13-3.89; P < .0001) than in the other hospital (RR = 1.86; 95% CI 1.36-2.55; P < .0001).

Conclusion: Our standardized antenatal class, which was performed in an area with a high rate of cesarean section, significantly reduced this rate, and this was still significant after adjustment for potential confounders.

Setting: Two health districts in the city of Caserta, Italy

Population of Focus: Primiparous and multiparous women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network--Facebook. A randomized clinical trial was performed involving 251 mother–child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age.

Intervention Results: The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001).

Conclusion: This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.

Study Design: Single-blind, RCT

Setting: Social media platform: Facebook

Population of Focus: Mother-child pairings assisted in the maternity ward of a Baby-Friendly Hospital who used Facebook

Sample Size: 251 mother-child pairings

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users.

Intervention Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays.

Conclusion: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.

Study Design: Observational study using surveys and electronic medical records

Setting: Providence St. Joseph Health's Consumer Innovation Team launched app in Portland, Oregon and greater Seattle, Washington areas/Online

Population of Focus: Women with four or more prenatal encounters at one of the seven selected clinics that gave birth to a live infant at a Providence hospital in the past 4-6 months

Sample Size: 567 women (167 in the app user group and 400 in the comparison nonuser group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): , Referrals, Expanded Insurance Coverage; Medicaid, Enrollment Assistance, PATIENT_CONSUMER, STATE, PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: The ACA Medicaid expansion is one of the most significant recent public investments in health insurance. The ACA was designed as a comprehensive reform of health care in the U.S., and one of its priorities was to reduce uninsurance. An important question in an evaluation of the Medicaid expansion is whether it had effects on health or well-being through enrollment in other social safety net prorams. This study investigates Medicaid expansion’s potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the U.S. Not all states participated in the ACA Medicaid expansion, and there was inconsistent timing among those who did. This state-time variation in implementation provides a natural experiment for investigating the relationship between the two programs. Our study contributes new evidence on an important policy topic.

Intervention Results: SNAP, by addressing nutritional needs, can improve social determinants of health. We find support for our first hypothesis that Medicaid expansion leads to greater SNAP participation. We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. The increase is likely a combination of new enrollments and continued participation among individuals who otherwise would have been disenrolled. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. More specifically, there is a 2.4 percentage point increase in the average rates of participation in Medicaid and SNAP for households with children implying that some low-income children benefit indirectly through more access to SNAP. Furthermore, the increase in SNAP in very low-income households is likely to provide substantial improvements in access to food. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs.

Conclusion: We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. This main finding is consistent with the Oregon Health Insurance Experiment, as well as the handful of ACA Medicaid expansion studies in this area of research. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs. Although SNAP is a federal program and Medicaid is a state-federal program, states can streamline applications, recertifications, and other hurdles to accessing and staying enrolled in these programs. We find no spillover effect for ABAWDs, however, who are a vulnerable group of adults that need additional outreach and support to access programs for which they may be eligible. Our findings contribute to a body of evidence that the Medicaid expansion does more than improve access to health care; it connects eligible low-income individuals to multiple supports. Enrolling in SNAP increases access to food, an important social determinant of health, and an investment in population health for states.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (States with Medicaid Expansion and SNAP)

Population of Focus: Adults/families under 138 percent of the federal poverty level on Medicaid

Sample Size: 414,000 individuals

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Expert Support (Provider), Notification/Information Materials (Online Resources, Information Guide), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER, PARENT_FAMILY

Intervention Description: We hypothesized that addressing barriers to scheduling in-person interpreters would make FCR encounters more likely, and thus ensure more equitable care for LEP patients.

Intervention Results: There were 614 encounters with LEP patients during the intervention, 367 of which included in-person interpreters. The percentage of encounters with LEP patients involving interpreters increased from 0% to 63%. Form completion, our primary process measure, reached 87% in the most recent phase. English-proficient and LEP patients reported similar satisfaction with their rounding experience amid a modest increase in rounds duration (preintervention, 105 minutes; postintervention, 130 minutes; P = .056).

Conclusion: Using quality improvement as a framework to address key barriers, we successfully implemented a process that increased the participation of in-person interpreters on FCRs on a busy pediatric service.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT_CONSUMER, Community Events, COMMUNITY, Nurse/Nurse Practitioner, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The study aimed to evaluate the effectiveness of a cervical cancer prevention education program for rural Korean immigrant women. A total of 46 Korean immigrant women who had not been screened in the past three years participated. The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12.

Intervention Results: The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12. Compared to the control group, significant increases were detected in level of knowledge of cervical cancer prevention (p = .001), behavioral attitude toward cervical cancer prevention (p = .029) and behavioral intention regarding cervical cancer prevention (p = .005) in the experimental group. Pap screening rate of the experimental group was significantly increased (p = .029), but the rate of change in the selection of primary care providers was not significant.

Conclusion: The results suggest the need for a multilevel approach to address cultural and systemic barriers to Korean immigrant women in promotion of cervical cancer prevention behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), , PATIENT_CONSUMER

Intervention Description: Lttle is known about the comparative effectiveness of these smoking cessation therapies among pregnant women.

Intervention Results: After propensity score-matching, our cohort comprised 60 women who used varenicline and 60 who used nicotine patches during the first half of pregnancy. More varenicline users (33.3%, 95% CI: 21.7%–46.7%) quit smoking than nicotine patch users (13.3%, 95% CI: 5.9%–24.6%). The adjusted rate difference was 24.2% (95% CI: 10.2%–38.2%) and the adjusted relative risk was 2.8 (95% CI: 1.4–5.7).

Conclusion: Varenicline was almost three times more effective than nicotine patches in assisting pregnant women to quit smoking. Further studies are needed to corroborate our results. Together with data on the safety of varenicline during pregnancy, evidence regarding the relative benefit of varenicline and NRT during pregnancy important for informing clinical decisions for pregnant smokers. This study is the first to measure the comparative effectiveness of varenicline and nicotine patches during pregnancy – women using varenicline were almost three times as likely to quit smoking than those using nicotine patches. This study addressed a clinically important question using an observational study, noting that there is an absence of evidence from randomized controlled trials because of the ethical issues associated with including pregnant women in clinical trials of medicines of unknown safety.

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Other Education, Patient-Centered Medical Home, PATIENT_CONSUMER, PARENT_FAMILY, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home.

Intervention Results: There was a significant improvement in fruit and vegetable intake and dining out (p = <.05), and a clinical improvement in physical activity and sugar sweetened beverage intake.

Conclusion: Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, PATIENT_CONSUMER, YOUTH

Intervention Description: To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers' abstinence and reduce child tobacco smoke exposure.

Intervention Results: AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = -0.15; SE = 0.04; P < .001) and condition by time (b = -0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.

Conclusion: The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation. Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Support/Counseling/Remediation, YOUTH, PATIENT_CONSUMER

Intervention Description: Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations.

Intervention Results: Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways.

Conclusion: Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Adult-led Support/Counseling/Remediation, Telephone Support, PATIENT_CONSUMER, YOUTH

Intervention Description: This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up.

Intervention Results: Compared with controls, children in FRESH had significantly lower cotinine (β= -0.31, p<0.01) and lower maternal-reported TSE (β= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (β= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75).

Conclusion: Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, , PATIENT_CONSUMER

Intervention Description: The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019.

Intervention Results: The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as “clear and comprehensive”. Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high.

Conclusion: In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers’ knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Enabling Services, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care.

Intervention Results: Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning.

Conclusion: Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Technology-Based Support, Telephone Support, PATIENT_CONSUMER

Intervention Description: This study was conducted to determine the effect of tele-education offered to mothers during the COVID-19 pandemic on breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Results: It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Conclusion: The researchers provided a 4-week long education and counseling service to mothers in the experimental group via direct phone calls and text messages. It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Pharmacotherapy (Nicotine), Referrals, PATIENT_CONSUMER

Intervention Description: The current randomized controlled trial (RCT) study aimed to evaluate the effectiveness of a multi-component smoking reduction intervention in parental smoking reduction and children's environmental tobacco smoke exposure reduction in clinical settings.

Intervention Results: Smoking parents in the intervention group had significantly more biochemically validated ≥50% smoking reduction than the control: 27.1 vs. 10.0% (OR = 3.34, 95% CI: 1.16-9.62, P = 0.02). The rate of self-reported ≥50% smoking reduction was also significantly higher in the intervention group than the control: 51.9 vs. 20.2% (OR = 4.40, 95% CI: 2.38-8.12, P < 0.001). For secondary outcomes, the rate of parental self-reported smoking cessation was higher in the intervention arm: 10.5 vs. 1.0% (OR = 12.17, 95% CI: 1.54-96.07, P < 0.001), however, no differences were detected in biochemically validated cessation and changes in children's passive smoke exposure between the groups.

Conclusion: Monthly smoking reduction counseling together with nicotine replacement therapy is more effective than simple verbal cessation advice in the smoking reduction for parents of pediatric patients. However, this study did not demonstrate differences in smoking cessation or reduction in children's passive smoke exposure with a 6-month follow-up. Achievement of a smoke-free environment remains challenging.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Supports, Social Media

Intervention Description: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates.

Intervention Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages.

Conclusion: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.

Study Design: Process evaluation

Setting: Social media platform: Facebook

Population of Focus: Pregnant African American women recruited through WIC

Sample Size: 472 women

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The current case study describes the application of Implementation Mapping to inform the selection and testing of implementation strategies to improve implementation of two behavioral health programs in a Care Coordination Program at a partnered FQHC.

Intervention Results: Results are presented by Implementation Mapping task, from Task 1 through Task 5. We also describe the integration of additional implementation frameworks (The Consolidated Framework for Implementation Research, Health Equity Implementation Framework) within the Implementation Mapping process to inform determinant identification, performance and change objectives development, design and tailoring of implementation strategies and protocols, and resulting evaluation of implementation outcomes.

Conclusion: The current project is an example of real-world application of Implementation Mapping methodology to improve care outcomes for a high priority population that is generalizable to other settings utilizing similar care models and health equity endeavors. Such case studies are critical to advance our understanding and application of innovative implementation science methods such as Implementation Mapping.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated.

Intervention Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times.

Conclusion: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Assessment, YOUTH, PATIENT_CONSUMER, Feedback, PARENT_FAMILY, Text Messaging

Intervention Description: This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas.

Intervention Results: Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM2.5. The median reduction experienced was 4.1 µg/m3 (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback.

Conclusion: Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information. Women randomized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention that included a combination of dietary, exercise, and behavioral strategies delivered by a research dietician and trained research assistants. Participants were provided with dietary advice consistent with current Australian standards to maintain a balance of carbohydrates, fat, and protein and to reduce intake of foods high in refined carbohydrates and saturated fats, while increasing intake of fiber and promoting consumption of two servings of fruit, five servings of vegetables, and three servings of dairy each day. Physical activity advice primarily encouraged women to increase their amount of walking and incidental activity.

Intervention Results: 2152 women and 2142 liveborn infants were included in the analyses. The risk of the infant being large for gestational age was not significantly different in the two groups (lifestyle advice 203/1075 (19%) v standard care 224/1067 (21%); adjusted relative risk 0.90, 95% confidence interval 0.77 to 1.07; P=0.24). Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g (lifestyle advice 164/1075 (15%) v standard care 201/1067 (19%); 0.82, 0.68 to 0.99; number needed to treat (NNT) 28, 15 to 263; P=0.04). There were no differences in maternal pregnancy and birth outcomes between the two treatment groups.

Conclusion: For women who were overweight or obese, the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes.

Setting: Three public maternity hospitals across South Australia

Population of Focus: Nulliparous and multiparous women with a BMI ≥25 and singleton gestation

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours, Female Provider, Needs Assessment, PATIENT_CONSUMER, HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Assessment (PATIENT_CONSUMER), Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice), COMMUNITY, Social Supports, Individual Supports,

Intervention Description: In 2014, the New York State WIC program launched the You Can Do it (YCDI) initiative in 12 WIC clinics. This multicomponent intevention, which was originally developed by the Vermont WIC program, was designed to improve participants' knowledge, attitudes, confidence, and social support to breastfeed exclusively through a screening and tailored counseling protocol combined with peer counselor and professional support spanning the prenatal and early postpartum periods. This multicomponent intervention paired with a yearlong learning community in the 12 clinics.

Intervention Results: Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts.

Conclusion: The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Study Design: Quasi-experimental study

Setting: 12 WIC clinics in New York State

Population of Focus: Prenatal women enrolled in WIC during the first trimester of pregnancy who intended to breastfeed or were undecided

Sample Size: Baseline cohort of 688 mother-infant dyads and two intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (n=362 monther-infant dyads) and non-BAPT (n=347 mother-infant dyads); 12 WIC clinics; 47 WIC staff members

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, PATIENT_CONSUMER, Educational Material, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study was a controlled trial study with longitudinal design. The sample consisted of 156 women (intervention = 78, control = 78) who registered in hearing-impaired associations in Izmir, Turkey. The education about cervical cancer and Pap smear test was given to intervention group with face-to-face interviews by using Turkish sign language. Three months later, the women were contacted and asked whether they have had a Pap smear test, and the total knowledge score of intervention groups was evaluated.

Intervention Results: There was not a statistically significant difference between the mean total score of knowledge about cervical cancer and Pap smear test in intervention (0.6 ± 1.6) and control (1.1 ± 1.9) groups. After 3 months, having a Pap smear test was found to be statistically significantly higher between groups (intervention = 29.5%, control = %1.2), and the mean cervical cancer and Pap smear knowledge score of the intervention group (9.2 ± 1.4) was found to be statistically significantly higher than the score before education (0.6 ± 1.6).

Conclusion: Education of cervical cancer and Pap smear test increased knowledge level and behaviour of Pap smear test of the women.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Provider Training/Education, Patient-Centered Medical Home, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This article provides recommendations for adapting the pediatric medical home (PMH) model for health care needs of youth in foster care.

Intervention Results: Preliminary evidence suggests that the PMH model of care may be ideal for addressing the complex and often underserved needs of youth in foster care and their families. The present recommendations provide a logistical framework for establishing a clinic that thoughtfully considers the unique needs of this population.

Conclusion: Future research is needed to examine best practices for implementation.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, PATIENT_CONSUMER, Educational Material

Intervention Description: This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21–74.

Intervention Results: Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40–74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87–7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77–4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21–64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact.

Conclusion: In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66–3.91) and PN only (OR: 2.35, CI: 1.88–2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation , Referrals, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, STATE, WIC Food Package Change, PATIENT_CONSUMER

Intervention Description: Based on Centers for Disease Control and Prevention’s Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertifcation visits; WIC staf referred children with potential concerns to their healthcare providers for developmental screening. WIC staf surveys and focus groups were used to assess initial implementation outcomes.

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusion: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

Setting: WIC clinics

Population of Focus: WIC clinic staff

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Referrals, YOUTH, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusion: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

Intervention Components (click on component to see a list of all articles that use that intervention): , , Technology-Based Support, PATIENT_CONSUMER

Intervention Description: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages).

Intervention Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study.

Conclusion: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Expert Support (Provider), Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This article discusses a multidisciplinary, family-centered medical home designed to address the needs of this special population.

Intervention Results: The NSP has become a primary referral source for local NICUs, with a total of 549 medically fragile infants enrolled from its inception in 2011 through 2016. Caregivers and patients experience psychosocial stressors at averages statistically significantly higher than the rest of the Commonwealth of Pennsylvania and the US. Although patients in the program use medical resources beyond that of typically developing infants, hospital utilization among this patient cohort is trending down.

Conclusion: Caring for medically fragile NICU graduates can be daunting for families given the array of necessary services, supports, and resources to maximize their potential. A multidisciplinary primary care medical home, such as the NSP, is a successful model of patient care demonstrating favorable associations with health care utilization, care coordination, and addressing/improving family functioning and their experience.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Intensive Therapy, PATIENT_CONSUMER, Psychoeducation

Intervention Description: Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here.

Intervention Results: Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the ‘decision aid’ helped reduce their fear (53 % vs 37 %, p = 0.02).

Conclusion: Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies.

Study Design: RCT

Setting: 3 antenatal clinics in three teaching hospitals

Population of Focus: Nulliparous women with measured fear of childbirth who gave birth after recruitment between May 2012 and June 20132,4

Data Source: Not specified

Sample Size: Total (n=104) Intervention (n=51) Control (n=53)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Adult-led Support/Counseling/Remediation, Educational Material, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER, YOUTH

Intervention Description: This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners.

Intervention Results: On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim;

Conclusion: these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: A randomized (1:1) controlled trial was conducted among 13 Portuguese primary care units, recruiting women aged 25 to 49 years, eligible for cervical cancer screening, with an available mobile phone number. In the intervention group, participants were invited for cervical cancer screening through automated/customized text messages and phone calls, followed by text message reminders. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women adherent to screening up to 45 days after invitation and the secondary outcome was defined as the adherence proportion after invitation based only on text messages and reminders.

Intervention Results: A total of 1220 women were randomized, 605 to intervention and 615 to control group. The adherence to cervical cancer was significantly higher among women assigned to intervention (39.0% vs. 25.7%, p < 0.001); this corresponds to a difference of 13.3% (95% CI 8.1 to 18.5). The difference in adherence between an invitation strategy based only on text messages and reminders and the standard of care was −0.4%, 95% CI −5.3 to 4.5.

Conclusion: In conclusion, an invitation to cervical cancer screening using automated text messages/phone calls and reminders increases the adherence to cervical cancer screening. Such a low-cost and operator-independent strategy of invitation may contribute to the sustainability of organized screening programs.

Setting: Primary care settings in Portugal

Population of Focus: Women ages 25-49

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25–49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation).

Intervention Results: Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001).

Conclusion: In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training.

Setting: Portuguese National Healh Care system, primary care screening

Population of Focus: Portuguese women ages 25–49 years, eligible for cervical cancer screening, with a mobile phone number available.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Lactation Consultant, Educational Material, Assessment (PATIENT_CONSUMER)

Intervention Description: Primary prevention utilizing consistent visits with lactation professionals with a group of new mothers may efficiently address a care gap to meet breastfeeding goals. Mother-infant dyads attending a newborn care clinic for 6 weeks received feeding assessment and standard-of-care guidance from an Internationally Board-Certified Lactation Consultant (IBCLC). This study is an evaluation of a cost-effective easy-to-deliver strategy provided to an at-risk population attending a primary care clinic in the normal course of postnatal care.

Intervention Results: The number and timing of IBCLC visits was correlated with EDB at 6 weeks PP. Maternal/infant dyads seen at day 3 had 2.5 times higher odds of EDB at 6 weeks than those not receiving IBCLC standard-of-care feeding assessment. Dyads seen at days 3 and 14 had 3.4 times higher odds of EDB than those with less follow-up. Bottle use correlated with decreased odds of AB at 6 weeks PP; similarly, dyads seen only at day 14 PP had decreased odds of EDB. When looking at timing of the first involvement, dyads seen at 3 days had higher odds of EDB than dyads first seen at day 14 PP.

Conclusion: This primary prevention strategy of early minimal intervention using an IBCLC increased the odds of EDB and AB at 6 weeks PP. These data support the conclusion that early feeding assessment the first 2 weeks PP with an IBCLC may increase breastfeeding at 6 weeks PP.

Study Design: Retrospective comparison cohort study

Setting: Hospital-affiliated primary care clinic serving the underinsured and uninsured in the community

Population of Focus: Mother-infant dyads attending a newborn care clinic

Sample Size: 640 mother-infant dyads

Age Range: Infants at 6 weeks postpartum

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, Incentives, Professional Support, COMMUNITY, Individual Supports,

Intervention Description: The Canada Prenatal Nutrition Program (CPNP) aims to improve birth outcomes and promote and support breastfeeding among vulnerable women. Using charitable donations, the Parkdale Parents' Primary Prevention Project (5Ps) CPNP provides postnatal lactation support to its clients in addition to standard prenatal services (group education workshops, individualized support from public health nurses and dieticians, community referrals, snacks, two public transit tokens, grocery store gift card, self-serve food bank, and childcare). This lactation support program was designed and implemented by 5Ps CPNP staff and includes three components: 1) gift package of breastfeeding and infant care supplies; 2) IBCLC visits within 48 h of referral; and 3) double electric breast pump.

Intervention Results: Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump.

Conclusion: This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women.

Study Design: Evaluation data

Setting: A Canada Prenatal Nutrition Program site in Toronto

Population of Focus: Pregnant women in the catchment area

Sample Size: 199 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, Transition Assistance, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home.

Intervention Results: YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program.

Conclusion: YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction. Practical implications: A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: An intervention was conducted from June 2015 to September 2015, in which reminders to schedule a Pap smear were sent to the remaining cohort of 473 women via sequential text messaging, followed by phone call attempts.

Intervention Results: Of all subjects, 94% contacted by text messages and 41% contacted by phone calls were successfully reached. There was an increase in the rate of completed Pap smears from 2.5% (12/485) at baseline to 11.8% (56/473) after interventions (p < 0.0001) in a period of three months. Out of the 68 Pap smear results, 20 (29.4%) were abnormal.

Conclusion: Our intervention, utilizing methods of communication such as text messaging and phone calls, markedly increased the rate of completed Pap smear screening in our population.

Setting: HIV Wellness Center, an outpatient center affiliated with University Medical Center (UMC) of Southern Nevada.

Population of Focus: HIV-infected women 18 and older who had no documented Pap result in the past year

Intervention Components (click on component to see a list of all articles that use that intervention): Diet/Exercise, PATIENT_CONSUMER

Intervention Description: The research team sought to assess the effects of pre-pregnancy physical fitness of AD soldiers as measured by the Army Physical Fitness Test (APFT) on the incidence of CD in AD women, in addition to examining known demographic and pregnancy risk factors in this cohort.

Intervention Results: Neither total APFT performance nor performance on the individual push-up, sit-up or run events in the 15 months prior to pregnancy was associated with mode of delivery. Excessive gestational weight gain (EWG) and neonatal birth weight were the only two factors independently associated with an increased rate of cesarean delivery. Women who had excessive gestational weight gain, were twice as likely to undergo CD as those who had adequate or insufficient weight gain (24% vs. 12%, p = 0.004). Soldiers delivering a neonate ≥4,000 g were 2.8 times as likely to undergo CD as those delivering a neonate <4,000 g (47% vs. 17%, p < 0.001). Age, race, and rank, a surrogate marker for socioeconomic status, were not associated with mode of delivery.

Conclusion: Pre-pregnancy fitness levels as measured by the APFT among healthy physically active nulliparous AD women showed no association with the incidence of labored CD. EWG is one modifiable factor which potentially increases the risk for CD in this cohort and has been documented as a risk factor in a recent metanalysis (RR-1.3). Counseling on appropriate weight gain in pregnancy may be the most effective way to reduce the rate of CD among this population of healthy and physically active women.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Group Education

Intervention Description: Researchers conducted a RCT to analyze a midwifery intervention that included oral health education, screening and referrals to existing dental pathways.

Intervention Results: Substiantial improvements in the use of dental services, women's oral health knowledge; quality of oral health and oral health outcomes were found statistically significant in the intervention group.

Conclusion: The Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.

Setting: Large metropolitan public hospitals

Population of Focus: Pregnant people

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Home Visits, Lactation Consultants, Peer Counselor, Professional Support,

Intervention Description: Breastfeeding education and support are core services provided by WIC, and numerous policies and initiatives ensure breastfeeding support is provided throughout the prenatal period and first year postpartum. Site-level characteristics related to staffing, policies, and practices that support breastfeeding were collected for the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITEPS-2). Study data included interviews with 27 WIC state agency representatives affiliated with study sites, site visits to all 80 sites to collect data on facilities and staffing and a one hour interview with a site supervisor or coordinator, and surveys with staff (n=802) working in each of the 80 sites during the period when participants were enrolled in the study.

Intervention Results: Five WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06–1.12; and odds ratio = 1.26, 95% confidence interval, 1.21–1.31, respectively).

Conclusion: Positive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports.

Study Design: Secondary analysis

Setting: WIC programs in 27 states

Population of Focus: Women enrolled in WIC for the first time for that pregnancy prenatally or before their infant was 2.5 months old in 80 WIC sites across 27 states and territories during the 20 week recruitment period

Sample Size: 1,235 mothers and their infants (80 WIC sites; 802 staff surveys)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We report on a unique model of patient care focused on providing patient-centered care and building trusting relationships.

Intervention Results: In the first 2 years of operation, demand for services rose rapidly and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation.

Conclusion: While marginalized populations have worse birth outcomes and far more infant deaths, making care accessible and responsive to patient needs while focusing on building patient relationships is an important strategy to improve outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Referrals, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities.

Intervention Results: The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS.

Conclusion: With use of existing resources, a medical home–Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Referrals, Education/Training (caregiver), STATE, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: We aimed to identify and describe the contextual factors that influence implementation of PNCC.

Intervention Results: Our findings support the need to study the implementation of perinatal public and community health interventions and consider “health in all policies.” Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period.

Conclusion: Nurses who provide PNCC have unique insights that should be leveraged to inform maternal–child health policy.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports

Intervention Description: We assessed whether increased use of breastfeeding smartphone applications (apps) impacts breastfeeding rates for low-income women. Women were randomized to one of two novel apps: control app containing digital breastfeeding handouts and BreastFeeding Friend (BFF), an interactive app containing on-demand breastfeeding educational and video content. The BFF app was a novel smartphone app designed based on a cross-sectional breastfeeding survey and feeback from focus group of postpartum, low-income African American women. Specifically, a multidisciplinary team of lactation consultants, perinatologists, and neonatologists designed the BFF app. The educational content included interactive advice on overcoming breastfeeding challenges, educational content on breastfeeding benefits, normal infant behavior and maternal postpartum physiology, strategies to optimize breastfeeding and pumping at work or school, hyperlinks to on-demand videos with tips and troubleshooting for successful latching, common breastfeeding positions, and using and cleaning a breast pump, as well as links to resources. All participants were given a complimentary Android smartphone with assigned breastfeeding app preloaded by a telecom provider.

Intervention Results: In the RCT, BFF and control app median uses were 15 (interquartile range [IQR] 4–24) and 9 (IQR 5–19) (p = 0.1), respectively. Breastfeeding initiation did not differ with app usage (84.1% in highest quartile versus 78.2% for lowest quartile; p = 0.5). Rates of sustained and exclusive breastfeeding through 6 months were similar between groups. Among both groups, smartphone apps were the most preferred breastfeeding resource at 6 weeks. Low quartile users also preferred alternative online breastfeeding resources: >50% of all users preferred technology-based breastfeeding resources.

Conclusion: Increased usage of breastfeeding apps did not improve breastfeeding rates among low-income women. However, technology-based resources were the most preferred breastfeeding resource after hospital discharge, indicating ongoing development of technology-based interventions has potential to increase breastfeeding in this high-needs population. clinicaltrials.gov (NCT03167073).

Study Design: Secondary analysis of an RCT

Setting: Prenatal clinic serving women with Medicaid or no health insurance at an academic medical center/Online

Population of Focus: Pregnant women at approximately 36 weeks' gestation recruited during routine obstetric appointments

Sample Size: 169 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home.

Intervention Results: Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office.

Conclusion: While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), , PATIENT_CONSUMER

Intervention Description: We report the results of a randomized controlled trial in 1,140 participants comparing refillable e-cigarettes with nicotine patches.

Intervention Results: Pregnant women who smoked were randomized to e-cigarettes (n = 569) or nicotine patches (n = 571). In the unadjusted analysis of the primary outcome, validated prolonged quit rates at the end of pregnancy in the two study arms were not significantly different (6.8% versus 4.4% in the e-cigarette and patch arms, respectively; relative risk (RR) = 1.55, 95%CI: 0.95–2.53, P = 0.08). However, some participants in the nicotine patch group also used e-cigarettes during the study. In a pre-specified sensitivity analysis excluding abstinent participants who used non-allocated products, e-cigarettes were more effective than patches (6.8% versus 3.6%; RR = 1.93, 95%CI: 1.14–3.26, P = 0.02). Safety outcomes included adverse events and maternal and birth outcomes. The safety profile was found to be similar for both study products, however, low birthweight (<2,500 g) was less frequent in the e-cigarette arm (14.8% versus 9.6%; RR = 0.65, 95%CI: 0.47–0.90, P = 0.01). Other adverse events and birth outcomes were similar in the two study arms.

Conclusion: E-cigarettes might help women who are pregnant to stop smoking, and their safety for use in pregnancy is similar to that of nicotine patches.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Community-Based Group Education, Other Person-to-Person Education, Patient Navigation

Intervention Description: We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland–Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months.

Intervention Results: The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving both tests were 17.4 (95% CI = 7.5, 40.3) times higher. Intervention effects also included increases in health literacy and positive perceptions about cancer screening.

Conclusion: A health literacy–focused CHW intervention successfully promoted cancer-screening behaviors and related cognitive and attitudinal outcomes in Korean American women.

Setting: 23 ethnic churches in the Baltimore,MD-Washington, DC area

Population of Focus: Korean American women who had not had a pap test in 24 months and who could read and write Korean or English

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Home Visits, Other Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: Illinois develped an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. They serve as specialized home visitors, providing home-based education and support during the last half of pregnancy and for 6 weeks postpartum. The doula worked with the mother more intensively during pregnancy and the first weeks postpartum, while the home visitor became the primary provider by 6 weeks postpartum. The goal of this randomized controlled trial is to examine whether young, low-income families receiving doula-home visiting services, compared to families receiving lower-intensity case management services, have improved maternal and child health outcomes during the period between birth and 3 months of age.

Intervention Results: Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05).

Conclusion: The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

Study Design: RCT

Setting: Doula-home visiting programs in high-poverty IL communities

Population of Focus: Women under 26 years of age, less than 34 weeks gestation, living in the program geographic catchment area

Sample Size: 312 young, pregannt woman across four communities

Age Range: Pregnant women under 26 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Peer Counselor, Lactation Consultant, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: LATCH -- Lactation Advice thru Texting Can Help is a pilot, web-based texting intervention designed to improve breastfeeding rates among mothers receiving WIC. The two-way texting intervention provided both evidence-based breastfeeding education through automated texts adn a mode for mothers to freely exchange texts with breastfeeding peer counselor (PC). In addition to providing breastfeeding education, the automated texts were personalized by addressing the mother by name and signed by the PC. These automatic personalized texts were sent out regularly both prenatally and in the immediate post-partum period to increase peer counselor points of contact with mom via text. The web-based texting platform allowed all text messages to be recorded, and thus, the on-site lactation consultants and WIC supervisors were able to monitor and supervise all text-based communication regularly.

Intervention Results: Primary outcomes included early post-partum (PP) contact and exclusive breastfeeding (EBF) rates at 2 weeks PP. Feasibility outcomes included text messaging engagement and mother's satisfaction with texting platform. Fifty-eight women were enrolled, 52 of whom were available for intention-to-treat analysis (n = 30 texting, n = 22 control). Contact between mothers and PCs within 48 hr of delivery was greater in the texting group (86.6% vs. 27.3%, p < .001). EBF rates at 2 weeks PP among participants in the texting intervention was 50% versus 31.8% in the control arm (p = .197). Intervention group mothers tended to be more likely to meet their breastfeeding goals (p = .06).

Conclusion: Participants were highly satisfied with the Lactation Advice thru Texting Can Help intervention, and findings suggest that it may improve early post-delivery contact and increase EBF rates among mothers enrolled in WIC who receive PC. A large, multicentre trial is feasible and warranted.

Study Design: Pilot RCT

Setting: WIC breastfeeding programs at a hospital-based primary care center and a federally qualified community health center/Cell phone

Population of Focus: Pregnant women at 18-30 weeks gestation from local WIC breastfeeding peer counselor programs

Sample Size: 52 women (30 texting and 22 control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth, Childbirth Education Classes, Midwifery, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Intervention Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Conclusion: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Study Design: Retrospective cohort

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between April 2004 to October 20102

Data Source: Not specified

Sample Size: Total (n=1,660) Intervention (n=830) Control (n=830)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Peer-Review of Provider Decisions, Elective Induction Policy, Guideline Change and Implementation, PATIENT_CONSUMER, Intensive Therapy, Psychoeducation

Intervention Description: We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital.

Intervention Results: The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001).

Conclusion: The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Incentives, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Residents/Medical Students

Intervention Description: Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.

Intervention Results: After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64–2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40–3.02; P < 0.001). Our clinic’s CCS rate improved from 70% to 75% after the 18-month intervention.

Conclusion: The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.

Setting: Urban academic internal medicine clinic

Population of Focus: Women ages 21-64 eligible for cervical cancer screening

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Other Education, Continuity of Care (Caseload), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: Mosquera et al provide us with pre–coronavirus disease 2019 data to reassure us that adding telemedicine access to an existing complex care medical home can be effective in improving both clinical and financial outcomes. This population of children all had ≥2 hospitalizations or ≥1 PICU admission in the previous year and a likely risk of future hospitalization at the time they were enrolled into the complex care clinic. Families were randomly selected to receive comprehensive care (experienced primary care physicians, 24/7 access by phone, same-day illness care on weekdays in clinic, hospital consult when inpatient) or comprehensive care plus audio-video telemedicine access. CMC with telemedicine access had 4 fewer days of care outside of the home per child-year, lower rates of serious illness, reduced hospital admissions, and reduced PICU admissions. The authors went further and documented a reduction in mean total health system costs of $7563 per child-year compared with a cost of only $308 per child-year to set up and conduct telemedicine visits.

Intervention Results: Experienced primary care providers who have an existing relationship with CMC and their caregivers do make a difference in the health of their most vulnerable patients. Adding telemedicine to their pediatric medical home can enhance that value even more.

Conclusion: Yet telemedicine in primary care continues to face challenges. Patients face 3 overlapping barriers to accessing telehealth: the absence of technology, digital literacy, and reliable Internet coverage. Together, these barriers comprise the digital divide, which disproportionately affects people of color, people living in rural areas, and those with low socioeconomic status. As we identify and debate solutions to the digital divide for vulnerable populations, we must partner with community agencies, schools, Internet service companies, and government leaders to overcome barriers to both technology access and digital literacy.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women.

Intervention Results: Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32‐29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37‐13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05‐5.75) although not 24- (AOR = 1.31; CI,0.54‐3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55‐3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk.

Conclusion: Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Other Education, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: Patient-centered medical homes (PCMHs) seek to provide primary care that is comprehensive, patient-centered, coordianted, accessible, and high quality. PCMHs have the potential to improve receipt of preventive services by automating reminders to patients, measuring adherence to recommended services, giving feedback to physicians about adherence rates, using clinical decision support embedded in electronic health record (EHR) systems, and other quality-related activities. The objective of this study was to measure pediatric preventive counseling at PCMHs compared with practices that reported undertaking some or no quality-related activities. We focus on 2 activities most directly related to the provision of recommended counseling by physicians: 1) whether the practice regularly gave physicians reports on the clinical quality of their care, and 2) if the practice had an EHR system, whether the system routinely reminded practitioners to provide guideline-based care or screening tests.

Intervention Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusion: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.

Study Design: Secondary data analysis

Setting: Patient-centered medical homes

Population of Focus: Children and adolscents who visited their office-based usual sources of care

Sample Size: 4814 children and adolescents

Age Range: Ages 0-17

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Referrals, Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities.

Intervention Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusion: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (caregiver), Enabling Services, PATIENT_CONSUMER, PROFESSIONAL_CAREGIVER

Intervention Description: To examine effects of maternity care coordination (MCC) on perinatal health care utilization among low-income women.

Intervention Results: Maternity care coordination recipients were more likely to receive first-trimester prenatal care (p < .01) and averaged three more prenatal visits and two additional primary care visits during pregnancy; they were also more likely to participate in WIC and to receive postpartum family planning services (p < .01). Medicaid expenditures were greater among mothers receiving MCC.

Conclusion: Maternity care coordination facilitates access to health care and supportive services among Medicaid-covered women. Increased maternal service utilization may increase expenditures in the short run; however, improved newborn health may reduce the need for costly neonatal care, and by implication the need for early intervention and other supports for at-risk children.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Expert Support (Provider), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: We evaluated the benefit of embedded diagnostic consultation within primary care clinics.

Intervention Results: Diagnostic clarity was determined through streamlined assessment for 59% of the children, while others required follow-up. Latency from first concern to diagnosis was 55 days and median age at diagnosis was 32 months: considerably lower than national averages or comparable tertiary clinics.

Conclusion: Findings support that embedded processes for effective triage and diagnosis within the medical home is a viable mechanism for efficient access to diagnostic services and assists in bypassing a common barrier to specialized services.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: To evaluate the impact of mobile phone text messages on breastfeeding practices.

Intervention Results: Exclusive breastfeeding prevalence was significantly higher in the intervention than in the control group for the 6 follow-up visits combined (RR: 1.48; 95%CI: 1.35, 1.63; P < 0.001) and at each monthly follow-up visit. At 6 mo, exclusive breastfeeding was 43.4% in the intervention compared with 15.3% in the control group (RR: 2.74; 95%CI: 1.79, 4.19; P < 0.001). Also, at 6 mo, the intervention increased current breastfeeding (RR: 1.17; 95%CI: 1.07, 1.26; P < 0.001) and reduced bottle feeding (RR: 0.30; 95%CI: 0.17, 0.54; P < 0.001). Exclusive breastfeeding was progressively higher in the intervention group than in the control group at each follow-up (P for interaction < 0.001) and similarly for current breastfeeding. The intervention increased the mean breastfeeding self-efficacy score (adjusted mean difference 4.0; 95%CI: 1.36, 6.64; P = 0.030). Over the 6-month follow-up, the intervention significantly reduced diarrhea risk by 55% (RR: 0.45; 95%CI: 0.24, 0.82; P < 0.009).

Conclusion: Regular, targeted text messages delivered to urban pregnant women and mothers via mobile phones significantly improve breastfeeding practices and reduce infant morbidity during the first 6 mo of life.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Other Education, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: A social worker coordinated medical care for children in foster care in a foster care medical home (FCMH) and tracked care coordination (CC) activities using a modified Care Coordination Measurement Tool© (mCCMT).

Intervention Results: The CC prevented 11 emergency department (ED) visits, 9 placement disruptions, and 42 patient privacy violations.

Conclusion: Children assigned to a FCMH have diverse CC needs and benefit from social workers’ specialized skills.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Transition Assistance, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To assess participation with a structured transition programme for adolescents with diabetes.

Intervention Results: Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Māori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036).

Conclusion: In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Māori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Reporting & Response System, YOUTH, CLASSROOM_SCHOOL, PATIENT_CONSUMER, Feedback

Intervention Description: This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups.

Intervention Results: PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes.

Conclusion: Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Professional Support,

Intervention Description: The aim of this study is to investigate the effectiveness of indivdualized intervention compared with routine care in improving rates of exclusive breastfeeding. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. More specifically, the intervention consisted of individual antenatal breastfeeding education and postnatal lactation support. Participants were visited by a researcher at hospital admission. At the time of admission, the researcher used the breastfeeding attrition prediction scale and individualized the intervention based on the results. After delivery, researchers provided professional guidance for mothers. After discharge, researchers asked for monthly details of the breastfeeding situation and gave guidance by telephone follow-up after maternal hospital discharge to postpartum 4 months. They also received the same routine antenatal and postnatal obstretric care.

Intervention Results: We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12–2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76–4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09–19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48–12.49).

Conclusion: The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.

Study Design: RCT

Setting: Hospital in China

Population of Focus: Women > 34 weeks gestation recruited from from the obstetric admission office

Sample Size: 352 women (176 intervention group and 176 control group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Other Education, PATIENT_CONSUMER, Provision of Breastfeeding Item, Educational Material

Intervention Description: Community forum participants voted for an education and resource distribution program (using a baby box) to help reduce local infant mortality.

Intervention Results: The proportion of participants at the follow-up survey who reported bed-sharing most or all of the time (5.7%) was lower than those participants who had said they were likely or very likely to bed-share in the post-education survey (11.3%). Although nearly all participants (98.6%) in the post-education survey reported that they were likely to use the baby box, at the postpartum follow-up, 39.1% reported actual use of the baby box.

Conclusion: The program positively impacted self-reported likelihood of several health behaviors. A community-driven approach to maternal education and resource distribution may be beneficial in other cities.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational material, HEALTH_CARE_PROVIDER_PRACTICE, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education,

Intervention Description: The purpose of this system-wide quality improvement project was to create a breastfeeding-friendly pediatric practice. This breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. The policy included: (a) breastfeeding promotion recommendations; (b) provider, nurse, and staff roles; (c) patient education and resources; and (d) breastfeeding-friendly atmosphere guidelines. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized throughout the offices. Lactation support services were publicized via signs and social media postings.

Intervention Results: Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusion: This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.

Study Design: Pre-post intervention

Setting: Multisite rural IL pediatric practice

Population of Focus: Mothers with breastfeeding infants from newborn to 4 months seen for well-child visits at a pediatric practice

Sample Size: 71 infants preintervention and 18 infants postintervention

Age Range: Newborn to infants 4 months old

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), Referrals, Other Person-to-Person Education, PATIENT_CONSUMER, Incentives

Intervention Description: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes.

Intervention Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). “Low” caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62–7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079);

Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Referrals, PATIENT_CONSUMER, Incentives

Intervention Description: The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network.

Intervention Results: The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI −0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort’s caregivers (difference in slope (control–intervention)=3.30 ng/mL/month, CI −7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control–intervention)=−1.59 ng/mL/month, CI −3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group.

Conclusion: Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Access to Provider through Hotline, Consultation (Parent/Family), PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.

Intervention Results: During the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]).

Conclusion: Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Provider Training/Education, Outreach (caregiver), PATIENT_CONSUMER, PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children.

Intervention Results: Serving 62 youth during its first year, the medical home has begun to improve access to high-quality healthcare to a very vulnerable population.

Conclusion: Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depression screening, and diabetic HbA1c monitoring. From 2014 to 2016, 16,590 underscreened women were randomized to receive a mailed kit or usual care Pap reminders within Kaiser Permanente Washington. We used logistic regression to estimate odds ratios (ORs) of preventive services receipt within 12-months between the intervention vs. control arms, and within the intervention arm (comparing those returning a kit vs. attending Pap vs. nothing), adjusting models for demographic variables.

Intervention Results: There were no significant between-arm differences in uptake of any of the preventive services: intervention vs. control: mammography OR = 1.01 (95% confidence interval:0.88–1.17), CRC screening OR = 0.98 (0.86–1.13), influenza vaccination OR = 0.99 (0.92–1.06), depression screening OR = 1.07 (0.99–1.16), HbA1c OR = 0.84 (0.62–1.13). Within the intervention arm, preventive services uptake was higher in women who completed cervical cancer screening vs. did not, with stronger effects for women who attended Pap: Pap vs. nothing: mammography OR = 11.81 (8.11–17.19), CRC screening OR = 7.31 (5.57–9.58), influenza vaccination OR = 2.06 (1.82–2.32), depression screening OR = 1.79 (1.57–2.05), HbA1c OR = 3.35 (1.49–7.52); kit vs. nothing: mammography OR = 2.26 (1.56–3.26), CRC screening OR = 5.05 (3.57–7.14), influenza vaccination OR = 1.67 (1.41–1.98), depression screening OR = 1.09 (0.89–1.33), HbA1c OR = 1.23 (0.57–2.65). Mailing HPV self-sampling kits to underscreened women did not negatively impact uptake of other preventive services. However, overall preventive service uptake was the highest among women who attended in-clinic cervical cancer screening.

Conclusion: Individuals who are overdue for cervical cancer screening remain a hard-to-reach population, even after removing barriers associated with in-person screening. While cervical cancer screening rates remained low,(Winer et al., 2019) mailing HPV kits improved cervical cancer screening rates and did not result in reduced uptake of other recommended preventive services.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Spport/Counseling/Remediation, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15 million clients, largely socio-economically disadvantaged, to social and health resources each year.

Intervention Results: Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness.

Conclusion: The intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Support/Counseling/Remediation, Educational Material (caregiver), PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER, YOUTH

Intervention Description: Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness.

Intervention Results: Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = -2.33, p < .0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of $9,633 for delivery to 100 households.

Conclusion: Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months.

Intervention Results: Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR] = 1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR = 0.58 [95% CI, 0.44, 0.78]).

Conclusion: In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent School-Based Program, Presentation/meeting/information Session (Classroom), CLASSROOM_SCHOOL, Intensive Therapy, PATIENT_CONSUMER

Intervention Description: To examine the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.

Intervention Results: There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the subsample, mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104 to -0.002, p < .05), suicidal ideation (b = -0.130, 95% CI -0.225 to -0.034, p < .01), and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p < .05) among high-risk victims in Preventure versus control schools. Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p < .05) showed greater reductions among high-risk bullies in Preventure versus control schools, and suicidal ideation showed greater reductions among high-risk female bullies in Preventure versus control schools (b = -0.820, 95% CI -1.198 to -0.442, p < .001).

Conclusion: The findings support targeting personality in bullying prevention.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Provider/Patient Communication Portal, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted.

Intervention Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC.

Conclusion: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.

Setting: Primary care setting

Population of Focus: Women ages 21-64 who received primary care within the past 12 months

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, Care Coordination, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: The objective was to evaluate healthcare outcomes (continuity of care and healthcare utilization) for clients enrolled in LIFEspan.

Intervention Results: Prospective enrolment comprised 30 ABI, 48 CP, and 21 SB participants. Retrospective enrolment comprised 15 ABI and 18 CP participants. LIFEspan participants demonstrated significantly greater continuity of care (45% had engagement with adult services in the year following discharge at 18 years), compared to the prospective SB group (14%). Healthcare utilization data were inconsistent with no significant changes in frequency of physician office visits, emergency department visits, or hospitalizations for clients enrolled in LIFEspan in the year following discharge, compared to the 2 years prior to discharge.

Conclusion: Introduction of the LIFEspan model increased continuity of care, with successful transfer from pediatric to adult services for clients enrolled. Data on longer-term follow-up are recommended for greater understanding of the degree of adult engagement and influence of LIFEspan on healthcare utilization following transfer.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: We conducted a pragmatic randomized trial comparing outreach by mailed letter or personalized phone call for patients overdue for cervical, breast, or colorectal cancer screening. The study was conducted at 6 clinics within an academic primary care organization in Toronto, Canada. Our primary outcome was an uptake of at least 1 screening test for which the patient was overdue. Our primary analysis was an intention-to-treat, unadjusted comparison of proportions, using a χ2 test. We also compared costs per additional patient screened. All analyses were stratified by sex.

Intervention Results: A total of 3733 females and 1537 males were randomized to receive 1 of the interventions. Among women, 33.0% allocated to receive a reminder letter and 41.2% allocated to receive a reminder phone call received at least 1 screening test for which they were due (absolute difference, 8.1%; 95% CI, 5.1%–11.2%, P < .001). Among men, 24.8% allocated to receive a reminder letter and 28.8% allocated to a reminder phone call received screening for colorectal cancer (absolute difference, 4.1%; 95% CI, −0.4% to 8.5%, P = .073). For women and men, the letters cost approximately CaD $5.07 and CaD $7.16, respectively, for each completed screening test compared with CaD $8.71 and CaD $12.00 for the phone calls.

Conclusion: Phone calls were more effective than mailed letters at increasing uptake for cervical, breast, and colorectal cancer screening among women. However, phone calls were more expensive than letters. Primary care practices should consider integrating phone call reminders into their practice, possibly as part of a targeted or staged approach to outreach for cancer screening.

Setting: Academic primary care

Population of Focus: Women 21+ eligible to receive cervical cancer and other preventive screening

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Nurse/Nurse Practitioner

Intervention Description: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management. Four rapid plan–do–study–act cycles were used. Tests of change included team engagement, patient engagement, eligibility screening, and case log management. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The interventions consisted of team meetings, a patient engagement tool, an eligibility screening tool, and case log management.

Intervention Results: Among the women who completed care at the clinic during the 60-day project period, 80% were uninsured and 86% were Hispanic. A total of 87% of women received effective care, which consisted of same-day Well Woman Health Care Program enrollment and a same-day Pap test or an appointment to return for a well-woman visit.

Conclusion: A multicomponent approach led to underserved women receiving equitable access to cervical cancer screening and timely enrollment in a cervical cancer screening program.

Setting: Federally qualified health center (FQHC) in Tucson, Arizona,

Population of Focus: Uninsured and underserved women ages 21-65

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER

Intervention Description: Low-risk nulliparous and multiparous women from 40 weeks gestation in a single general hospital in Cambridgeshire, UK were offered CAM (complementary therapy and alternative medicine) including acupressure, reflexology, and aromatherapy. 647 received standard care during labor, and 397 received CAM.

Intervention Results: CAM did not have an effect on rates of induction of labour in nulliparous or multiparous women attending the post-dates clinic. However, we noted that nulliparous women who received CAM had shorter labours (mean 8.4 vs 10 h, p = 0.0002), less oxytocin augmentation (23% vs 35%, p = 0.0002), lower epidural rates (41% vs 50.5%, p = 0.02) and reduced blood loss regardless of mode of delivery (mean reduction 82ml, p = 0.03; 95%CI = -159 to -5). There were no significant differences in secondary outcomes when CAM was used in multiparous women apart from a 5.3 times increased risk of significant perineal trauma (6% vs 2%, p = 0.004) and those who had their labours induced after CAM had a higher risk of requiring an emergency caesarean section (5% vs 1%, p = 0.012). There was no difference on shoulder dystocia and neonatal admissions rates with CAM.

Conclusion: There is no reduction in induction of labour rates with the use of CAM. The other effects of CAM on labour and delivery outcomes are varied and potentially only beneficial in a selected group of women. Further research must be carried out before making any clear recommendations on its use.

Setting: One general hospital in Cambridgeshire, UK.

Population of Focus: Low risk women from 40 weeks gestation who were referred to the clinic by their community midwife or obstetric team.

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This summary describes activities conducted in the following study: A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial. See https://publications.aap.org/pediatrics/article/143/3/e20182738/76790/A-Telehealth-Enhanced-Referral-Process-in for a full description. Intervention: Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models.

Intervention Results: A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, >80% of eligible intervention and control participants (174 of 213) went on to an MH visit.

Conclusion: A novel telehealth-enhanced referral process developed by using a community-partnered approach improved initial access to CMHCs for children referred from primary care.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, Telephone Support, PATIENT_CONSUMER

Intervention Description: The present study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery occurred remotely using a mobile app. If efficacious, this remote intervention would allow pregnant women residing in geographically remote areas to benefit from incentives-based cessation interventions.

Intervention Results: Outcomes were analyzed using repeated measures analysis based on generalized estimating equations (GEE). Seven-day point prevalence abstinence rates were greater in the incentives versus best practices arms early- (46.7% vs 20.0%, OR = 3.50, 95%CI = 1.11,11.02) and late-antepartum (36.7% vs 13.3%, OR = 3.76, 95%CI = 1.04,13.65), and four- (36.7% vs 10.0%, OR = 5.21, 95%CI = 1.28,21.24) and eight-weeks postpartum (40.0% vs 6.7%, OR = 9.33, 95%CI = 1.87,46.68), although not at the 12- (23.3% vs 10.0%, OR = 2.74, 95%CI = 0.63,11.82) or 24-week (20.0% vs 6.7%, OR = 3.50, 95%CI = 0.65,18.98) postpartum assessments likely due to this pilot study being underpowered for discerning differences at the later assessments, especially 24-weeks postpartum which was three months after treatment completion.

Conclusion: These results support the efficacy of this remote, incentives-based intervention for pregnant smokers. Further research evaluating its efficacy and cost-effectiveness in a well-powered, randomized controlled trial (https://www.sciencedirect.com/topics/medicine-and-dentistry/randomized-controlled-trial) appears warranted.

Intervention Components (click on component to see a list of all articles that use that intervention): Online Material/Education/Blogging, Technology-Based Support, PATIENT_CONSUMER

Intervention Description: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying.

Intervention Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=-.66, SE 0.08, P=.04 at 8 weeks and β=-.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02).

Conclusion: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education.

Intervention Results: The My Baby Now app was offered to pregnant women 20–30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36–38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8–12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1–T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1–T2 and T1–T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1–T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions.

Conclusion: Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Planning for Transition, Transition Assistance, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: The research aimed to analyse the implementation in an initial cohort of patients of a new programme of transition to adult care based on a case

Intervention Results: The cohort included 500 patients, with malignant brain tumour (n = 56 (11%)), obesity (n = 55 (11%)), type 1 diabetes (n = 54 (11%)), or other disease (n = 335 (67%)). Their median age at transfer was 19, and the sex ratio was 0.5. At median 21 months of follow-up, 439 (88%) had a regular follow-up in or outside the hospital, 47 (9%) had irregular follow-up (absence at the last appointment or no appointment scheduled within the time recommended), 4 had stopped care on doctor's advice, 4 had died, 3 had moved, and 3 had refused care. The programme involved 9615 case management actions; 7% of patients required more than 50 actions. Patients requiring most support were usually those affected by a rare genetic form of obesity.

Conclusion: Case managers successfully addressed the complex needs of patients. Over time, the cohort will provide unprecedented long-term outcome results for patients with various conditions who experienced this form of transition.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Telephone Support, Lactation Consultant, Home Visits,

Intervention Description: The establishment of Loving Support Peer Counseling Programs (LSPCP) services in Washington State began in April 2005 when 5 local WIC agencies accepted USDA funding to implement the program. The model is structured according to evidence-based curricula with a focus on benefiting WIC recipients via mother-to-mother support regarding breastfeeding initiation and continuation. Peer counselors typically consist of women who were or are WIC clients and who successfully breastfed their children. An important characteristic of this program is the ability of peer counselors to provide breastfeeding support off-site and after clinic hours.

Intervention Results: Both PHSKC and CHIFMG clinics with a LSPCP expressed significant (P < .001) improvement in BF initiation and BF duration for >6 months. The likelihood that women enrolled in WIC would initiate BF at PHSKC clinics increased by 3%, whereas those in CHIFMG clinics increased by 6.8%. Women receiving services in smaller PHSKC clinics (n < 60 women) were likely to breastfeed their infants at >1 week. The proportionalities of non-Hispanic and black participants in PHSKC clinics were the primary and secondary predictors of the likelihood of BF discontinuing between 7 and 28 days' duration. In addition, clinics serving participants who spoke Tigrigna had increased rates of BF for a minimum of 6 months.

Conclusion: Findings may be used to reevaluate funding allocations, secure grants to reduce program constraints to stabilize LSPCP, develop strategies to reduce BF cessation at larger clinics, and improve peer counseling and other BF support to black and non-Hispanic women in the early postpartum period. The findings contribute to the study of the effects of LSPCP on BF initiation and duration while furthering a scholarly understanding of the way in which the WIC program interacts with participant characteristics at 2 local WIC agencies in Washington State.

Study Design: Nonrandomized treatment and control

Setting: Public Health-Seattle and King County (PHSKC), Catholic Health Initiatives Franscian Medical Group (CHIFMG)

Population of Focus: Women enrolled in WIC

Sample Size: PHSKC: n=15,290 women; CHIFMG: n=3582 women

Age Range: Infants from birth through 8 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, Telephone Support, YOUTH, PATIENT_CONSUMER

Intervention Description: This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking.

Intervention Results: Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002).

Conclusion: Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Baby Friendly Hospital Initiative, COMMUNITY, Individual Supports,

Intervention Description: The Westside Healthy Start Program (WHS), located in Chicago, Illinois, developed an ongoing multilevel approach to breastfeeding promotion. Key elements of the WHS breastfeeding model include individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety-net hospital to implement the Baby Friendly Hospital Initiative and provide lactation support to delivering patients. All WHS participants receive general breastfeeding education from case managers throughout pregnancy (such as information about breastfeeding benefits) and one face-to-face visit from a BFC in the third trimester for more personalized and comprehensive support. WHS collaborates with the largest delivering hospital in the service area, a safety-net provider, to improve the breastfeeding environment and systems of care.

Intervention Results: In the year our model was implemented, 44.6% (49/110) of prenatal WHS participants reported that they planned to breastfeed, and 67.0% (183/273) of delivered partici- pants initiated. Among participants reaching 6 months postpartum, 10.5% (9/86) were breastfeeding. WHS also had 2667 encounters with women delivering at our partner hospital during breastfeeding rounds, with 65.1% of contacts initiating. Community data was not available to assess the efficacy of our model at the local level. However, WHS participants fared better than all delivering patients at our partner hospital, where 65.0% initiated in 2015.

Conclusion: Healthy Start programs are a promising vehicle to improve breastfeeding initiation at the individual and community level. Additional evaluation is necessary to understand barriers to duration and services needed for this population.

Study Design: Evaluation data

Setting: Westside Healthy Start program located in Chicago, IL

Population of Focus: Low-income, African-American women who are pregnant

Sample Size: 652 women

Age Range: Women <17 to 45 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes, Intensive Therapy

Intervention Description: As an adjunct to standard antennal education, courses in complementary labor and delivery therapies were conducted at one of the two hospital venues over a 15-month period from May 2012 to August 2013. The underlying philosophy and specific techniques covered were designed to support a woman during pregnancy and labor by introducing tools to enhance a natural state of relaxation (visualization, yoga postures, breathing techniques, massage, acupuncture, and facilitated partner support. The courses present the concept of birth as a natural physiological process and teach methods to help laboring patients manage pain using complementary tools. The Complementary Therapies for Labour and Birth (CTLB) study protocol was based on the She Births Antenatal Education Program, with an acupressure component.

Intervention Results: There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25).

Conclusion: The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence.

Setting: Two public hospitals in Syndney, Australia

Population of Focus: Low-risk nulliparous women with a singleton pregnancy and cephalic presentation

Intervention Components (click on component to see a list of all articles that use that intervention): Continuity of Care (Caseload), Patient-Centered Medical Home, Other Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: NCQA’s PCMH Recognition Program is the most widely adopted PCMH evaluation program in the country. Required elements for recognition include demonstrating team-based care, population care management and accountability, patient access and engagement and the skills to do performance measurement and improvement.

Intervention Results: These services allow our trainees, staff and faculty to ask the hard questions about food security and housing stability as they feel they have onsite support for families.

Conclusion: The unique needs of our families, including the social determinants that accompany poverty, and our responsibility as the primary teaching site for future pediatricians, presents challenges. However, these factors also provide us with great incentives: to assure optimal health and development for our high-risk population and provide trainees with solid training in patient-centered, team-based care, quality measurement, accountability for costs and outcomes, a focus on population health and dedication to data-driven system improvement.

Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, PATIENT_CONSUMER, CLASSROOM_SCHOOL, Self-Regulation, YOUTH, Adult-led Support/Counseling/Remediation

Intervention Description: The current study aimed to explore the impact of a school-based mindfulness intervention on bullying behaviors among teenagers

Intervention Results: The results were as follows: (1) the post-test scores of trait mindfulness and self-control in the experimental group significantly increased (p < 0.01) while the scores of bullying behavior significantly decreased (p < 0.01); (2) trait mindfulness was positively associated with self-control (r = 0.13 to 0.63, p < 0.05), whereas trait mindfulness and self-control were both negatively associated with bullying behavior (r = -0.38 to -0.13, p < 0.05); and (3) the mediating effect of self-control accounted for 50% of the overall effect of trait mindfulness on bullying behavior.

Conclusion: These findings demonstrated that the school-based mindfulness intervention distinctly improves trait mindfulness and self-control and reduces bullying behavior among teenagers. Moreover, self-control plays a mediating role between trait mindfulness and bullying behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Oral Health Education

Intervention Description: Using a diverse, population-based sample of California women with a live birth, researchers examined whether medical providers' promotion of oral health and women's receipt of dental care during pregnancy has changed in recent years. Researchers used data from a population-based survey of postpartum women in 2009 and 2012 in California to compare the prevalence of women's self-reports that, during pregnancy, (a) their medical providers discussed oral health and/or suggested they see a dentist, and (b) they received dental care during pregnancy. Researchers also examined whether women's receipt of dental care during pregnancy was associated with whether their medical providers discussed oral health or suggested that they see a dentist.

Intervention Results: The proportion of women reporting that their medical providers talked about oral health or referred them to a dentist increased significantly overall (from 36 to 42%, and 21–26%, respectively, p < 0.001). The proportion of women with a dental visit during pregnancy also increased, from 38% in 2009 to 42% in 2012 (p < 0.005). Women whose medical providers promoted oral health care were approximately two times more likely to report having had a dental visit during pregnancy, even after adjusting for several potential confounders.

Conclusion: Medical provider promotion of oral health increases dental attendance of pregnant women. Characteristics of women reporting that their medical providers promoted, and that they received, dental care during pregnancy in 2012 suggests that the increases in promotion and use of oral health care were largely concentrated among Medi-Cal recipients. Further improvement is needed for all populations of pregnant women. Both public and private providers need to incorporate promotion of and referral for dental care into routine prenatal care protocols.

Setting: Clinic/Medical provider office

Population of Focus: Pregnant people

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: Alongside increasing social media use worldwide, there is an expanding research focus on how social media use affects health behaviours, decisions and perceptions. The objective of this study was to systematically determine if and how breastfeeding is promoted and supported on the popular social media platform Instagram, which currently has over 700 million active users worldwide. To assess how Instagram is used to depict and portray breastfeeding, and how users share perspectives and information about this topic, we analysed 4,089 images and 8,331 corresponding comments posted with popular breastfeeding-related hashtags (#breastfeeding, #breastmilk, #breastisbest, and #normalizebreastfeeding).

Intervention Results: We found that Instagram is being mobilized by users to publicly display and share diverse breastfeeding-related content and to create supportive networks that allow new mothers to share experiences, build confidence, and address challenges related to breastfeeding. Discussions were overwhelmingly positive and often highly personal, with virtually no antagonistic content. Very little educational content was found, contrasted by frequent depiction and discussion of commercial products.

Conclusion: Instagram is currently used by breastfeeding mothers to create supportive networks and could potentially offer new avenues and opportunities to "normalize," protect, promote, and support breastfeeding more broadly across its large and diverse global online community.

Study Design: Qualitative study

Setting: Social media platform: Instgram

Population of Focus: Active Instagram users who shared perspectives and information about breastfeeding with popular breastfeeding-related hashtags

Sample Size: 4,089 images and 8,331 corresponding comments

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material,

Intervention Description: To evaluate the the impact of a standardized bundle of educational videos delivered via the bedside television to postpartum mothers on exclusive breastfeeding rates. The University of Minnesota Masonic Children's Hospital uses an interactive patient care tool called the GetWellNetwork, which is viewable through a patient's inroom television. The hospital's information technology team created a bidirectional interface to integrate the Epic electronic health record (EHR) with the interactive patient care tool; this allowed providers to place medical orders for educational videos to be viewed directly in patient's television screens. Once the order is placed, the patient receives a notification on their screen to view the video(s), and when they use their television remote to activate the video, it is documented in the EHR. The standard postpartum order set was updated to include orders assigning 4 breastfeeding discharge education videos to all mothers for viewing on their in-room televisions. These videos augmented existing breastfeeding support by providing education to mothers on topics including hand massage and manual expression, hands-on pumping, latch holds, and maximizing milk production.

Intervention Results: Our data set included 3115 newborns (1467 pre- and 1648 postintervention). In the postintervention year, the exclusive breastfeeding rate at discharge was 69.5% vs 68.4% preintervention (P value: .80). Most mothers (81.3%; 1339) watched all 4 videos, and 308 mothers (18.7%) watched none. The mothers who watched all 4 videos were more likely to breastfeed exclusively (72.7% vs 55.3%) and less likely to exclusively formula feed than the mothers who watched none (1.1% vs 19.8%; P < .0001).

Conclusion: There was no change in exclusive breastfeeding rates pre– versus post–video education intervention. However, most mothers watched all 4 videos, and those who did were significantly more likely to engage in any breastfeeding (98.9%) compared with those who watched none (80.2%) during the postpartum hospitalization.

Study Design: Retrospective chart review

Setting: University of Minnesota Masonic Children's Hospital

Population of Focus: Mothers with gave birth in the MN hospital pre- and post-intervention

Sample Size: 3115 live births (1467 pre- and 1648 post-intervention)

Age Range: Women ages 24-36 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Peer Counselor, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: The LATCH study was a multisite study designed to test the effectiveness of a 2-way text messaging intervention encouraging exclusive breastfeeding among women enrolled in WIC, combining in-person prenatal and postpartum breastfeeding education and support (breastfeeding peer counseling) with mobile health technology (text messaging). Four WIC BFPC sites in Connecticut participated in the study. The effectiveness of BFPCs was clearly established in the literature; thus, the text messaging intervention was designed to faciliate the BFPCs' work, not replace it.

Intervention Results: Lactation Advice Through Texting Can Help had a significant impact on early contact between participants and BFPCs (odds ratio = 2.93; 95% confidence interval, 1.35–6.37) but did not have a significant impact on EBF (odds ratio = 1.26; 95% confidence interval, 0.54–2.66).

Conclusion: Lactation Advice Through Texting Can Help has the potential to facilitate the work of BFPCs by shortening the time-to-first-contact with clients after giving birth. Research is needed to identify the level of breastfeeding support staff coverage that WIC clinics must have to meet the demand for services created by Lactation Advice Through Texting Can Help.

Study Design: Multisite, single-blind RCT

Setting: WIC breastfeeding peer counselor program/Cell phone

Population of Focus: Low-income women participating in the WIC BFPC program

Sample Size: 174 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Other Education

Intervention Description: One approach for improving breastfeeding support and alleviating breastfeeding disparities is the implementation of a clinic-based peer counselor. The objective was to assess the "real life" effects of an autonomous peer counselor who provides tailored support to low-income, minority women based on individual needs. The peer counselor provided one-on-one antenatal and postpartum lactation support.

Intervention Results: Peer counselor exposure was not associated with the primary outcome of continued breastfeeding at 6 weeks (55.6% with peer counselor versus 49.1% without; aOR 1.26, 95% CI 0.69–2.31). However, women with peer counselor exposure were more likely to be satisfied with breastfeeding training at the time of delivery (98.2% vs. 83.6%, p = 0.006) and were more likely to have performed any breastfeeding (89.8% vs. 78.9%, p = 0.04), which remained significant on multivariable analysis (aOR 2.85, 95% CI 1.11–7.32).

Conclusion: Peer counselor interventions are a promising approach to increase breastfeeding initiation. Further research is required to inform the most efficacious approach while also allowing peer counselors to operate independently and in line with the specific needs of their clients.

Study Design: Secondary analysis of a prospective cohort study

Setting: Prenatal clinic in Chicago, IL

Population of Focus: Women receiving publicly funded prenatal care during the 6 months before and after introduction of a peer counselor

Sample Size: 218 women enrolled; 119 women had no peer counselor and 99 were enrolled after the peer counselor began working with patients

Age Range: Women 18+ years old

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Continuity of Care (Caseload), Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: The goal of this study was to evaluate the impact of integrating CHWs into the medical teams of children with HL and identify the social needs associated with their caregivers at a large urban hospital center.

Intervention Results: Of the 30 charts reviewed, 93% demonstrated social needs including food insecurity (24%) and educational service needs (45%). Eighty-seven percent of caregivers reported a sense of control over the child's condition, yet 73% reported a stress level of four or greater on the distress thermometer scale. At 3 months follow-up, 70% of patients completed referrals; a significant number of patients had obtained hearing aids and cochlear implants compared to baseline (p = 0.017).

Conclusion: Caregivers of children with HL face multiple social obstacles, including difficulties connecting to educational and financial resources. CHWs are instrumental in identifying social needs and connecting caregivers to services.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, NATIONAL, Policy/Guideline (National),

Intervention Description: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. This study is one of the few studies to include and measure access to breastfeeding support such as breast pumps, worksite programs, educational materials, support groups, lactation consultants, and workplace policies. To meet the 6 month recommendation, employers can provide additional resources (i.e. lactation consultants and support groups) to help mothers transition back to work and continue breastfeeding. The ACA was an important first step for establishing minimum resources to support breastfeeding mothers; however, it needs to be expanded to cover all employer and workers.

Intervention Results: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups.

Conclusion: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.

Study Design: Online, cross sectional survey

Setting: Policy

Population of Focus: Working mothers between the ages of 18 and 50 years old who gave birth in the previous two years

Sample Size: 52 women

Age Range: 18-50 year old women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Telephone Support, Lactation Consultant, Home Visits,

Intervention Description: As part of its ongoing efforts to promote and support breastfeeding, Minnesota WIC in 2005 began offering peer counseling through local programs, utilizing the Loving Support model. By 2012, peer counselor programs in Minnesota were active in 14 local agencies, covering 23 counties, and 2 tribes. Peers provide telephone counseling to pregnant and postpartum women up until the infant's first birthday, with referral to an International Board Certified Lactation Consultant when necessary. Other program components such as face-to-face meetings, text messaging, and home visiting vary across agencies.

Intervention Results: Among women who accepted referral into a PC program, odds of initiation were significantly higher among those who received peer services (Odds Ratio (OR): 1.66; 95% CI 1.19–2.32), after adjusting for confounders. Women who received peer services had a significantly lower hazard of breastfeeding discontinuation from birth through 12 months postpartum than women who did not receive services. (Hazard Ratio (HR) month one: 0.45; 95% CI 0.33–0.61; months two through twelve: 0.33; 95% CI 0.18–0.60). The effect of peer counseling did not differ significantly by race and ethnicity, taking into account mother’s country of origin.

Conclusion: Receipt of peer services was positively associated with breastfeeding initiation and continued breastfeeding from birth through 12 months postpartum. Making peer services available to more women, especially in communities with low initiation and duration, could improve maternal and child health in Minnesota.

Study Design: Retrospective analysis of observational data

Setting: Minnesota's WIC program

Population of Focus: WIC-enrolled women who accepted referral to a peer counseling program while pregnant

Sample Size: 2,219 women and their infants

Age Range: Infants birth through 12 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Patient-Centered Medical Home, Enabling Services, STATE, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study assessed the Collaborative’s impact on access to coordinated care within patient-centered medical homes (PCMH).

Intervention Results: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Conclusion: After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Peer Counselor, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: A breastfeeding-friendly physician’s office that applies the 13 recommendations of the Academy of Breastfeeding Medicine can help increase the exclusivity and duration of breastfeeding. Having already published the results up to five months of age of this intervention in our pediatric practice, we now report on the follow up to 36 months.

Intervention Results: The rates of any breastfeeding at discharge and at 1, 3 and 5 months (n = 252) were 95.2, 95.8, 89.3 and 86.5%, respectively. At 8, 12, 18, 24 and 36 months of age, the rates of breastfeeding were 70.6% (163/231), 59% (135/229), 35% (78/224), 24.6% (55/224) and 7.2% (16/224), respectively.

Conclusion: The rates of any breastfeeding recorded in our pediatric practice up to age 36 months, are much higher than those reported elsewhere in high income countries and are likely to be associated with our baby-friendly and biological nurturing approach.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Professional Support, PATIENT_CONSUMER

Intervention Description: This study aimed to investigate the impact of introducing a smartphone-based daily feedback and counseling platform between women after delivery and a multidisciplinary lactation support team on lactation rates and various maternal and neonatal outcomes. Counseling was provided via a specifically developed application from a multidisciplinary team (obstetricians, nurses, lactation counselors, and psychologist) in an attempt to assist and counsel to maintain lactation.

Intervention Results: A total of 197 patients were recruited, 97 in the App group and 100 in the control group. The 2 groups did not differ in any background or delivery characteristics. The App group showed higher rates of lactation 6 weeks after delivery (96.9% vs 82.0%; P<.001) and 3 months after delivery (81.4% vs 69.0%; P=.049) than the control group. Patients in the App group reported excellent satisfaction from the use of the application and their overall postnatal care.

Conclusion: Our study has provided further information on the growing efficacy of technology platforms in obstetrical care. The introduction of a smartphone-based daily feedback and counseling platform between postpartum patients and a multidisciplinary lactation support team increased the lactation rates after delivery with excellent patient satisfaction.

Intervention Components (click on component to see a list of all articles that use that intervention): Collaboration with Local Agencies (State), Peer Counselor, Other Education, PATIENT_CONSUMER, STATE

Intervention Description: Once recruited and engaged, parent partners are encouraged to hold meetings with other parents within the practice to share their experiences by discussing practice processes, workflows that are related to scheduling, referral coordination, telephone callbacks, patient portal communications, practice policies, and on-call protocols. Practices within the PAMHI practice network have used this feedback to inform practice quality improvement with demonstrable results, such as improved efficiency with phone trees, better immunization rates, better customer service, and more ideas for practice events. Parent partners also participate as part of the practice’s quality improvement team, teach medical students and residents as “family faculty,” and provide support to other parents in the practice. Some PAMHI practices and their parent partners have held “resource nights,” during which they invite a group of parents along with community partners into the practice to share ideas and resources.

Intervention Results: For other states, pediatrics practices, and hospital systems that are seeking to adopt similar programs, there are several key considerations, including the following: (1) recognizing the value of and evidence for parent partners in the adoption and implementation of the medical home model, (2) identifying strategic partners to assist in training and professional development for the parent partner role in practice, (3) establishing a formal role for parent partners as equal practice team members, and (4) ensuring that parent and/or caregiver feedback is garnered from parents across the practice and using the feedback of their experiences for meaningful quality and practice improvement to uphold the quadruple aim of health care.

Conclusion: The PAMHI parent advisor and/or parent partner role can be replicated and successful in other pediatric practice settings to foster the quadruple aim of health care. The PAMHI can be used to serve as a model of how pediatric practices can adopt medical home concepts, specifically patient- and family-centered care with parent partners, into their practices. The staff members of the PAMHI have found that parent partners are successful when they possess the following qualities: • are parents and/or caregivers of CSHCN experiencing multiple systems of care; • have not recently received a new diagnosis for their children; • can provide candid feedback regarding practice policies and procedures; can promote linkages between other parents; • possess good listening and communication skills and can interact professionally with practice administration and staff; • can help support a child’s care plan; • can speak to other parents beyond their own experiences with their children; • recognize that they have valuable expertise and experiences to share; • possess resiliency, empathy, and a genuine desire to help other parents; and • have the time to devote and agree to be a parent partner.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation—overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face-to-face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers.

Intervention Results: Findings identified that local BSF groups are widely used and highly valued for their connection with local face-to-face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self-efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well-being, motivation and breastfeeding duration. As such, they have the potential to add value to local face-to-face services and improve breastfeeding experiences and knowledge in communities.

Conclusion: The findings have important implications to support the development of integrated online interventions to improve public health.

Study Design: Qualitative study

Setting: Social media platform: Breastfeeding Support Facebook groups

Population of Focus: Mothers in the UK using local Breastfeeding Support Facebook groups

Sample Size: 2028 mothers

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, PATIENT_CONSUMER, Midwifery, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: One specific form of support that is under researched is the use of Breastfeeding Support Facebook (BSF) groups that are aimed at supporting women in specific local areas, often with links to face to face support. Initial research highlights that mothers’ value these groups but the role that midwives play in offering support to local mothers through these groups has not been examined. The aim of this study was therefore to examine mothers’ perceptions of midwifery support for breastfeeding delivered through these groups, specifically when midwives played an active role in being a group ‘moderator’ or leader.

Intervention Results: Moderation was an important factor in mothers’ experiences, with trained support associated with greater engagement and more frequent visits, impacting on perceptions of group ethos, reliability and inclusivity. Midwife moderation was uncommon (5% of groups) but valued: midwife moderators offered a high level of support to mothers in their groups, with 87.5% having received midwife support often or sometimes and 97.8% rating this useful or very useful. Access to a midwife moderated group was also associated with viewing local face to face midwifery support for breastfeeding more positively. This is a significant finding, highlighting that online support complements face-to-face support in local settings (67% of groups were linked to a physical group), and improves continuity of care (14% of mothers who had midwife moderators received care from them). As such midwife moderated or supported groups have the potential to add value to local face to face services and improve breastfeeding experiences in communities.

Conclusion: The findings have important implications to support the development of integrated online interventions to improve public health.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Transition Assistance, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: This study evaluated the services delivered within a care coordination program at a transition consultation center for CSHCN. It also compared the advancement of youth by age group toward graduation criteria.

Intervention Results: The comparison of services for those with diagnoses of autism spectrum disorder, cerebral palsy and Down syndrome were uniformly high in supporting primary care and health care financing. Medicaid waiver assistance was provided more frequently to younger adolescents while older adolescents more commonly received support in all other graduation criteria, including primary and specialty care, healthcare financing and decision-making supports.

Conclusion: Youth served in a transition care coordination program receive a high volume and broad array of services. There are some variations in the types of services by diagnosis and level of support need. Older youth show greater advancement toward graduation criteria. Practice implications: This in-depth chart review provides a valuable description of the activities of care coordinators serving CSHCN enduring transition. It enables development of targeted strategies for building care coordination programming and sets an example for the design of future research studies on this topic.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence-based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared.

Intervention Results: The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non-PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward-oriented interaction (% composition, E-I index: 47% professionals, -0.18; 41% interested citizens, -0.67; 12% companies, -0.18), limiting opportunities for evidence-based dissemination to the lay public.

Conclusion: Although more tweets about peer-reviewed research findings were sent compared with tweets about nonevidence-based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network-based intervention.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers in the breastfeeding space on Twitter

Sample Size: 3,798 unique individuals (users), 3,962 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: As recently highlighted by the National Academy of Sciences, there is a need for the scientific community (SC) to diffuse its findings to the public more effectively online, as means to counteract the spread of misinformation. In response to this call, we gathered data from Twitter for one month from major breastfeeding hashtags resulting in an interconnected social network (n = 3,798 users). We then identified 59 influencers who disproportionately influenced information flow using social network analysis. These influencers were from the SC (e.g. academics, researchers, health care practitioners), as well as interested citizens (IC) and companies. We then conducted an ego-network analysis of influencer networks, developed ego maps, and compared diffusion metrics across the SC, IC and company influencers. We also qualitatively analyzed their tweets (n = 711) to understand the type of information being diffused.

Intervention Results: Content analysis of tweets suggest IC are more active than the SC in diffusing evidence-based breastfeeding knowledge, with 35% of their tweets around recent research findings compared to only 12% by the SC. Nonetheless, in terms of outreach to the general public, the two-step networks of SC influences were more heterogenous than ICs (55.7 ± 5.07, 50.9 ± 12.0, respectively, P<0.001).

Conclusion: Collectively, these findings suggest SC influencers may possess latent potential to diffuse research and evidence- based practices. However, the research suggests specific ways to enhance diffusion.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers from the scientific community using major breastfeeding hashtags on Twitter for a month

Sample Size: 59 influencers, 711 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, Educational Material, PATIENT_CONSUMER

Intervention Description: We aimed at exploring the role of teenagers as facilitators of change in enforcing a home no-smoking rule following school-based anti-tobacco programs and examining the effect of home no-smoking rule on teenagers’ intention to smoke.

Intervention Results: In all, 351 students participated. At baseline, 47.5% in the intervention group reported a home no-smoking rule and 86% indicated being unlikely to smoke, these increased to 61.3% (p=0.016) and 98.2% (p<0.001) at followup, respectively. Cohen’s d value was calculated to estimate the effect size of intervention. A large effect size of intervention was found in the intervention group (d=1.24), whilst d=0.19 in the control group.

Conclusion: Our study showed that our intervention led to the increase of no-smoking rules at home and to a negative intention towards smoking of adolescents. Consequently, we provide evidence that students are effective vehicles for carrying anti-smoking messages to their home environment including the no-smoking rule. Additionally, we confirmed previous reports that home no-smoking rule is associated with a negative intention to smoke and risk of smoking.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: This study explored the relationship between attendance of set curriculum childbirth education class and the labor and birth process, as well as maternal satisfaction with the birth experience. The class is taught by certified educators and the general curriculum is set by the International Childbirth Education Association. Classes provide information relating to healthy pregnancy, anatomy and physiology, stages of labor, relaxation, pain management, comfort measures, labor positions, breathing and pushing techniques, common medical interventions and pain medications, birth planning, cesarean birth, postpartum care for the family, early newborn care, and basic breastfeeding information. Tours of the maternity center are encouraged and offered outside of the class. The classes average 6 couples per series with a maximum of 10. Participants in the study were 197 low-risk, primiparous women, self-selected into two groups consisting of 82 women who attended a childbirth class and 115 women who did not. Data were collected from medical records and a postpartum satisfaction survey was completed by each participant. 

Intervention Results: Data analysis revealed that women who took a class were less likely to be induced and had lower use of analgesics during labor. A logistical regression model showed that an increase in the number of interventions increased the risk for cesarean surgery for all women. Labor interventions were used significantly less in women who took a childbirth class. No statistical difference was seen in the perception of control or overall satisfaction of the birth experience.

Conclusion: Childbirth education may help women prepare for what to expect in birth and minimize the use of medical interventions.

Setting: Nonprofit mid-size hospital in Alaska

Population of Focus: Low risk primiparous women

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Telephone Support, Adult-led Support/Counseling/Remediation, YOUTH, PATIENT_CONSUMER, Incentives

Intervention Description: The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment.

Intervention Results: Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) per one additional smoker who quit. The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker.

Conclusion: This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment.

Intervention Results: The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker.

Conclusion: This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Professional Support, Peer Counselor, PATIENT_CONSUMER

Intervention Description: The aims of this study were to describe levels of perceived informational social support among mothers in an online virtual community and to determine which features of the virtual community were perceived most favorably by breastfeeding mothers.

Intervention Results: In regard to online social support specific to information seeking, the reported social support was moderate to high (M=35.53, range=17–48). Most items had a score average of approximately 3, indicating that participants perceived informational support “Pretty often” from their group interactions. Participants in this study had an average Breastfeeding Self-Efficacy–Short Form score of 57.91, indicating a moderately high level of breastfeeding self-efficacy. Content analysis of open-ended items regarding favorable characteristics of the virtual community indicated participants appreciated the immediacy of feedback and the presence of lactation support professionals within the community.

Conclusion: Mothers in the lactation professional-led virtual community perceived moderately high support in health information seeking and experienced moderately high breastfeeding self-efficacy. Additional work is needed to determine the impact of participation in virtual communities on breastfeeding outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder, PATIENT_CONSUMER, Telephone Support

Intervention Description: Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year.

Intervention Results: A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age.

Conclusion: The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.

Setting: Pediatric practies

Population of Focus: Parents and caregivers

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Educational Material, Motivational Interviewing, PATIENT_CONSUMER, Feedback

Intervention Description: This study aimed to change parents’ perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children’s exposure [NIH.

Intervention Results: Parental perceptions of exposure (PPE) were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = −3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered.

Conclusion: By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Pharmacotherapy (Nicotine), Referrals, YOUTH, PATIENT_CONSUMER

Intervention Description: To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years.

Intervention Results: Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]).

Conclusion: In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, Educational Material, YOUTH, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Screening Tool Implementation

Intervention Description: The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use.

Intervention Results: Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke.

Conclusion: Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Referrals, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER, Telephone Support

Intervention Description: Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services.

Intervention Results: One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone.

Conclusion: Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.

Setting: Community-based

Population of Focus: Children and families

Intervention Components (click on component to see a list of all articles that use that intervention): Diet/Exercise, PATIENT_CONSUMER

Intervention Description: This multicenter cohort study examined the association between leisure time physical activity the year before pregnancy and during pregnancy and mode of delivery.

Intervention Results: The odds of emergency caesarean section decreased with increasing levels of physical activity with statistically significant trends at all four time stages except the third trimester. This tendency was confirmed in the proportional odds model showing 28% higher odds of a more complicated mode of delivery among women with a low activity level compared to moderately active women.

Conclusion: We found increasing leisure time physical activity before and during pregnancy associated with a less complicated delivery among low-risk, nulliparous women.

Setting: Hospitals in Denmark

Population of Focus: Nulliparous women who delivered a singleton infant in cephalic presentation at term after spontaneous onset of labor

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Pharmacotherapy (Nicotine), PATIENT_CONSUMER

Intervention Description: The aim of this pilot study was to establish the feasibility and potential efficacy of providing motivational advice and NRT (MA+NRT) to families of NICU infants.

Intervention Results: The primary outcome was accepting NRT patches (MA+NRT) and use of NRT. Bayesian analyses modeled NRT use as a function of treatment group. Most MA+NRT participants (81.3%; n=13) accepted the patches. No Quitline participants called the Quitline. NRT use differed across groups, indicating a 0.907 posterior probability that a positive effect for MA+NRT exists (RR=2.32, 95% CI=[0.68-11.34]).

Conclusion: This study demonstrated feasibility and acceptability for offering NRT and motivational advice to NICU parents and supports further intervention refinement with NICU families.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Home Visit (caregiver), PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: The Team for Infants Exposed to Substance abuse (TIES) Program provides a holistic, multi-disciplinary, community-based model to address the complex needs of families with young children affected by maternal substance use.

Intervention Results: A multi-year implementation study of the model yielded results that indicate the effectiveness of this home-based family support intervention. The model focuses on reducing maternal alcohol and other drug use, increasing positive parenting, promoting child and maternal health, and improving family income and family housing. A key component of the model is establishing a mutual, trusting relationship between the home visiting specialists and the family. Foundational to the TIES model is a family-centered, culturally competent, trauma-informed approach that includes formal interagency community partnerships

Conclusion: This article describes elements of the model that lead to high retention and completion rates and family goal attainment for this unique population.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Community-Based Group Education, COMMUNITY, Other Media

Intervention Description: The objective of this study was to determine the feasibility and effectiveness of translating films, and whether the use of narrative is an effective vehicle for producing changes in knowledge, attitudes, and behaviors regarding cervical cancer compared with a nonnarrative film. A randomized controlled telephone trial surveyed the effectiveness of two films our team produced among a sample of 300 monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin. Participants were recruited using random digit dialing (RDD) procedures from 2013 to 2014 in Los Angeles County and were randomly selected to view either a narrative or nonnarrative film. Data were collected by phone at baseline, 2 weeks, and 6 months after viewing. On average, participants arrived in the USA 25 years ago. The majority reported having less than high school education and limited English proficiency.

Intervention Results: Compared with their nonnarrative counterparts, women who received the cervical cancer–related information in the narrative film showed a significantly greater increase in new knowledge (p = 0.01) and in supportive attitudes about Pap tests expense (p = 0.05). Importantly, at 6 months, although not statistically significant, women who viewed the narrative film were also more likely to have had or scheduled a Pap test (62% vs 42%).

Conclusion: Narratives are a useful and underutilized tool to communicate information about cancer prevention. These findings have important implications for the delivery of health education among Spanish-speaking, low-literacy immigrant women, and for the reduction of cancer-related disparities.

Setting: Los Angeles county, CA

Population of Focus: monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation.

Intervention Results: Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum.

Conclusion: Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, , PATIENT_CONSUMER, Feedback

Intervention Description: We offered 102 participants smoking cessation advice, using motivational interviewing and exhaled carbon monoxide measurements to help them quit smoking.

Intervention Results: In total, 16 of 102 participants quit smoking, with 4 lost to follow-up. A further 40 participants cut down on how much they smoked.

Conclusion: Formal screening questions on smoking and the provision of smoking cessation advice should form a regular part of all respiratory clinics where CYP and their parents are seen. Simple smoking cessation interventions can lead to reduced smoking in this population.

Intervention Components (click on component to see a list of all articles that use that intervention): Integration into Adult Care, Transition Assistance, Care Coordination, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes.

Intervention Results: The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months.

Conclusion: Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, PATIENT_CONSUMER, Educational Material,

Intervention Description: In this pilot study, the breastfeed care plus intervention program was implemented to support women and their families in breastfeeding success.

Intervention Results: Both interventions proved to be effective in improving the ‘perception of breastfeeding self-efficacy,' with higher scores being found in the experimental group (p < 0.001). The proportion of exclusive breastfeeding was also higher in the experimental group

Conclusion: The BCP intervention program, during the first 120 days postpartum, showed promissory results in improving ‘perception of breastfeeding self-efficacy’ compared to conventional care, favoring breastfeeding duration and exclusivity, and cumulative breastfeeding competence of women/families.

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, Pediatric to Adult Transfer Assistance, Integration into Adult Care, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The transition of patients with Prader-Willi syndrome (PWS) to adult life for medical care is challenging because of multiple comorbidities, including hormone deficiencies, obesity and cognitive and behavioral disabilities. To assess endocrine management, and metabolic and anthropometric parameters of PWS adults who received (n = 31) or not (n = 64) transitional care, defined as specialized pediatric care followed by a structured care pathway to a multidisciplinary adult team.

Intervention Results: Among the entire cohort, 35.8% received growth hormone (GH) during childhood and 16.8% had a GH stimulation test after completion of growth. In adulthood, 14.7% were treated with GH, 56.8% received sex-hormone therapy, whereas 91.1% were hypogonadic and 37.9% had undergone valid screening of the corticotropic axis. The main reason for suboptimal endocrine management was marked behavioral disorders. Patients receiving transitional care were more likely to have had a GH stimulation test and hormonal substitutions in childhood. They also had a lower BMI, percentage of fat mass, improved metabolic parameters and fewer antidepressant treatments. Transitional care remained significantly associated with these parameters in multivariate analysis when adjusted on GH treatment.

Conclusion: A coordinated care pathway with specialized pediatric care and transition to a multidisciplinary adult team accustomed to managing complex disability including psychiatric troubles are associated with a better health status in adults with PWS.

Study Design: Retrospective cohort study

Setting: Hospital/clinicbased

Population of Focus: Age 16 or older with Prader-Willi syndrome

Data Source: Medical records, survey

Sample Size: 95; 31 Intervention group, 64 Non- intervention group

Age Range: 16-19 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports

Intervention Description: To test the effects of weekly SMS for improving infant feeding practices and infant weight. SMS were sent automatically using a web-based SMS messaging platform from the time the participant enrolled in the study until the end (4 months later). Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for 4 months. Intervention SMS were created with a focus on reinforcing WIC messages on breastfeeding, preventing overfeeding, delaying introduction of solid foods, and delaying and reducing baby juice comsumption. A total of 18 messages (1 per week for 4 months) were sent. All messages were written at a grade 5 level in Spanish for PR or English for HI.

Intervention Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.

Study Design: Multisite RCT

Setting: WIC programs in Puerto Rico and Hawaii/Cell phone

Population of Focus: Caregivers of infants 0-2 months old participating in the WIC program

Sample Size: 170 participants (86 control and 84 intervention)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: We evaluated how revisits and costs of care varied in a 12-month period between children in a care coordination program at our center (enrolled after hospital discharge with a tracheostomy or on a ventilator) and children with complex chronic condition discharges who were not enrolled.

Intervention Results: Seventy patients in the program were compared with 56 patients in the control group. On bivariate analysis, the median combined number of hospitalizations and ED visits in 2018 was lower among program participants (0 vs 1; P = .033), and program participation was associated with lower median total costs of care in 2018 ($700 vs $3200; P = .024). On multivariable analysis, care coordination program participation was associated with 59% fewer hospitalizations in 2018 (incidence rate ratio: 0.41; 95% confidence interval: 0.23 to 0.75; P = .004) but was not significantly associated with reduced ED visits or costs.

Conclusion: The care coordination program is a robust service spanning the continuum of patient care. We found program participation to be associated with reduced rehospitalization, which is an important driver of costs for children with medical complexity.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Educational Material, PATIENT_CONSUMER, YOUTH

Intervention Description: This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children.

Intervention Results: Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route.

Conclusion: Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Educational Material, PATIENT_CONSUMER

Intervention Description: To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas.

Intervention Results: A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = −18.70, p < 0.01) and attitudes (t = −2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers’ practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses.

Conclusion: The mobile intervention improved participants’ knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: Social media crosses socioeconomic and geographic lines and can inform and empower people, increase communication speed, and mobilize partnerships. Through the dissemination of standardized messages and graphics, social media can be optimized for the delivery of evidence-based nutrition information. In 2014, the USDA launched a mobile-responsive Web site to assist WIC staff in engaging participants and community partners. Resources included posters, brochures, videos, widgets, graphics, and BF peer counseling training. Recognizing the opportunity for spreading messages via social media, the Web site was enhanced with the addition of a social media toolkit for World Breastfeeding Week/National Breastfeeding Month (August, 2016). The goal of the project was to create sample graphics and messages based on the campaign that could be used by WIC agencies and partners to reach participants, eligible participants, and the public. Messages were developed using content from the Loving Support campaign materials and Loving Support Peer Counseling Training. Agencies were encouraged to link to the Loving Support Web site and use the hashtag #WICLovingSupport in their posts. Agencies could also customize the messages and graphics as needed to promote their own activities and events. The toolkit included Facebook covers and posts, Twitter headers and posts, a Twibbon, an Instagram post, and an e-card. A guide to using the toolkit with sample messages was created as well. The Figure shows sample images and messages.

Intervention Results: The toolkit was launched on July 12, 2016 and received 4,319 page views by the end of August. Overall there were 9,432 downloads of all Loving Support materials and 29,745 page views to the Loving Support Web site. This was a 50% increase in page views and a 17% increase in downloads over the previous month, before the launch of the toolkit. Use of the toolkit continued since August with 1,507 page views between August, 2016 and February, 2017. The number of users for that same period was 5,007 (new and returning users). There were 2,342 downloads of social media graphics, with Facebook covers and posts, the e-card, and Instagram posts as the most downloaded items. The Twibbon campaign had 36 supporters. A TweetReach snapshot report from August 2 to August 6 (during World Breastfeeding Week) showed that the hashtag #WICLovingSupport had 60 tweets from 40 contributors, 287,820 accounts reached (the number of people who likely saw content), and 362,607 impressions (the number of times people likely reached).

Conclusion: Translating policy and guidance into action-oriented messages that WIC agencies can easily use and disseminate can increase the exposure of evidence-based nutrition messages. Although it is a relatively low-cost communication strategy, social media involves a high cost in time and attention needed to maintain an active presence.8 By providing a ready-to-go social media toolkit, the Food and Nutrition Service was able to offer consistent messaging, but it also reduced WIC staff workload and reached many people with information about BF promotion and support.

Study Design: Program evaluation

Setting: Social media platforms: Facebook, Twitter, and Instagram

Population of Focus: WIC staff

Sample Size: 5,007 new and returning users

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, Motivational Interviewing, Telephone Support, PATIENT_CONSUMER

Intervention Description: In this report, we provide a cohort profile, and 8-week prolonged abstinence (8-week PA) and relapse findings from the first year of follow-up (n = 233).

Intervention Results: We found: (1) 28.4% achieved 8-week PA, (2) At a median of 6.2 months of follow-up after achieving 8-week PA, 23.2% of enrolled subjects reported tobacco cessation, and (3) a high rate of loss to follow-up (44%). In addition, our modeling indicated that the odds of relapse/smoking after enrollment was significantly higher in young mothers, non-Hispanic mothers (White, Black/African-American), mothers in the first and third trimester, and rural mothers.

Conclusion: Formative quantitative and qualitative research on the CTTP cohort will consider the effects of a range of implementation science (number of intervention sessions, addition of a mHealth component, distance to care) and individual (partner/household smoking, birth outcomes, NICU) outcome measures for the purpose of scaling up the CTTP model.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: Participants in this study included both normal-weight (NW; n = 201) and overweight or obese (OW/OB; n = 200) women, who were randomly assigned to receive standard care (n = 200) or a behavioral intervention to prevent excessive gestational weight gain. The intervention included one face-to-face visit; weekly mailed materials that promoted an appropriate weight gain, healthy eating, and exercise; individual graphs of weight gain; and telephone-based feedback. 

Intervention Results: Intent-to-treat analyses showed that the intervention, compared with standard care, decreased the percentage of NW women who exceeded IOM recommendations (40.2% compared with 52.1%; P = 0.003) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum (30.7% compared with 18.7%; P = 0.005).

Conclusion: A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women. This trial was registered at clinicaltrials.gov as NCT01117961.

Setting: Six obstetric offices in Providence, RI

Population of Focus: BMI between 19.8 and 40

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Referrals, STATE, Mini Grants, Public Insurance (State)

Intervention Description: Small grants to community-based organizations have been shown to be effective in garnering the involvement of the local community in health promotion efforts. The Georgia Utilization Mini-grant Program leveraged modest funding and resources to promote community involvement to improve enrollment and utilization of Medicaid and CHIP services for children. It demonstrates how a state Medicaid agency can step outside its usual administrative role to play an important part in supporting local outreach and marketing efforts to promote Medicaid/CHIP enrollment and utilization.

Intervention Results: Funded community-based organizations improved utilization of children’s health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. Responses suggest that the program improved levels of enrollment, appointment-setting and referrals for social and other services. Common facilitators and barriers to success and ways to address them were also identified.

Conclusion: Elaboration on each of the facilitators of success led to the development of several recommendations as guidance for future outreach funding programs such as: staffing, data systems, collaboration and how to address incentives and barriers.

Study Design: Participatory approach

Setting: Community (Community-based organizations)

Population of Focus: Children enrolled in Medicaid and PeachCare

Data Source: Questionnaires, telephone interviews, one-on-one counseling, application assistance, home visits

Sample Size: 6 organizations

Age Range: Children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone.

Intervention Results: Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%–12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction.

Conclusion: Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. A disseminable texting program helped some pregnant women quit smoking.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Other Education, Referrals, PATIENT_CONSUMER

Intervention Description: Our nationally recognised enriched medical home intervention (EMHI) utilised community health worker home visitation to improve health outcomes of children by engaging the entire family and removing barriers to care-seeking.

Intervention Results: The EMHI participants were primarily families with infants <24 months old, Medicaid-insured and Latino. In the multivariable logistic regression model, EMHI program factors as well as community factors independently predicted program continuation and retention. Specifically, families learning about newborn care or with preferred spoken language Spanish were more likely to complete the program. Participants reporting neighbourhood distrust had a greater likelihood of non-completion than others. Results underscore the importance of cultural competency and community involvement in program design and dissemination.

Conclusion: Our findings are applicable to other home-based interventions with the goal of supporting underserved families in following recommended clinical care.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: The present study aims at evaluating the impact of the COVID-19 pandemic on breastfeeding consultations in LactApp (a mobile application [app] for m-Health focused on breastfeeding support, www.lactapp.com) during the COVID-19 pandemic.

Intervention Results: LactApp active users increased by 12,092 users (p < 0.001) during the COVID-19 outbreak and confinement and queries consulted in LactApp also significantly increased by 10,899 queries per month after the pandemic outbreak. The breastfeeding topics that significantly increased are those related to growth spurts, breastfeeding stages, breastfeeding technique, breast pain and mastitis, problems with infants not gaining weight correctly, hypogalactia, increased milk demand, and relactation. These findings are important to understand the potential of online tools when face-to-face professional support is unavailable.

Conclusion: Critical issues in breastfeeding establishment were highly consulted and significantly increased in the app during the pandemic. We believe that LactApp was a useful tool for breastfeeding support when women could not obtain appropriate support elsewhere. LactApp might be considered a powerful tool to identify critical issues of breastfeeding and trends in an automatized manner.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Adult-led Support/Counseling/Remediation, PATIENT_CONSUMER, YOUTH, Feedback

Intervention Description: This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied.

Intervention Results: The intervention increased women’s capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others’ smoking in the home.

Conclusion: The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Enabling Services, Outreach (Provider), PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, PROFESSIONAL_CAREGIVER

Intervention Description: The purpose of this study was to describe how each practice operationalized clinical–community linkage strategies that best suited their setting and to determine if efforts resulted in improved MIHP participation and other service use.

Intervention Results: When compared with similar women from the rest of the state, the Federally Qualified Health Center observed a 9.1 absolute percentage points (APP; 95% confidence interval [CI], 8.1–10.1) increase in MIHP participation and 12.5 APP (95% CI, 10.4–14.6) increase in early first trimester enrollment. The obstetrics and gynecology residency practice experienced increases of 4.4 APP (95% CI, 3.3–5.6) in overall MIHP participation and 12.5 APP (95% CI, 10.3–14.7) in first trimester enrollment. Significant improvements in adequate prenatal care, emergency department use, and postpartum visit completion were also observed.

Conclusion: Clinical–community linkages can significantly improve participation of Medicaid-insured women in an evidence-based home visiting program and other prenatal services. This work is important because health providers are looking for ways to create clinical–community linkages.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, , PATIENT_CONSUMER

Intervention Description: The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic’s and disaster’s effects.

Intervention Results: In phase one, breast-feeding ‘Challenges’ identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. ‘Assets and facilitators’ included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential.

Conclusion: Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.

Intervention Components (click on component to see a list of all articles that use that intervention): Online Material/Education/Blogging, Technology-Based Support, PATIENT_CONSUMER

Intervention Description: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization.

Intervention Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3.

Conclusion: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (Provider), PATIENT_CONSUMER, Diet/Exercise

Intervention Description: The intervention program consisted of two individual counseling modules given by trained researchers at the 20th and 30th week of gestation. The sessions were structured and comprised three main topics: nutrition, physical activity, and gestational weight gain monitoring. The dietary intervention aimed at decreasing the intake of energy-dense foods and high-fat foods (e.g. fast food, sweets, and sugar-sweetened beverages) by substituting them with low-fat alternatives, and increasing the consumption of fruit, vegetables, and whole grain products. The advice on physical activity was in accordance with the current guidelines for physical activity during pregnancy from the Society of Obstetricians and Gynecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG). The following recommendations were introduced for women using the FITT (frequency, intensity, time, type) criteria: thirty minutes of moderate intensity activity on most days of the week at an appropriate heart-rate zone. Non weight-bearing or low-impact endurance exercises using the large muscle groups like walking, cycling, swimming, or aquatic exercises were proposed. Participants were provided with a list of adequate local prenatal exercise programs and advised to participate in programs like these. 

Intervention Results: The intervention resulted in a lower proportion of women exceeding IOM guidelines among women in the intervention group (38%) compared with the control group (60%) (odds ratio (OR): 0.5; 95% confidence interval (CI): 0.3 to 0.9) without prompting an increase in the proportion of pregnancies with suboptimal weight gain (19% vs. 21%). Participants in the intervention group gained significantly less weight than those in the control group. Only 17% of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31% of those in the control group at month four postpartum (pp) (OR: 0.5; 95% CI: 0.2 to 0.9). There were no significant differences in obstetric and neonatal outcomes.

Conclusion: Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain, and may exert favorable effects on pp weight retention.

Setting: Eight gynecological practices in Munich Germany

Population of Focus: Healthy nulliparous and multiparous pregnant women

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Referrals, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the medical home while decreasing wait times.

Intervention Results: Fifty-eight percent of patients referred for a dermatologic complaint were scheduled in RASH clinic. Wait times for new patient appointments in RASH clinic were significantly shorter than for new dermatology appointments in the previous 12 months (mean 36 days vs 65 days, P < .001). The monthly number of referrals to dermatology also decreased significantly after the RASH clinic opened (24/month vs 12/month, P < .001). Ten percent of RASH patients were referred on to dermatology. In a survey of PCPs (N = 67), 76% said the RASH clinic was “extremely/very helpful.”

Conclusion: Providing dermatologic care to low or moderate complexity patients within the medical home is feasible and leads to better access to care. This innovative model could be spread to other clinics and subspecialties.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Incentives,

Intervention Description: The effect of financial incentives to improve breastfeeding prevalence is unknown. The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015 and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk.

Intervention Results: In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, −0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, −0.2 to 4.8; P = .07).

Conclusion: Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data.

Study Design: Cluster randomized trial

Setting: Electoral wards in England

Population of Focus: Mother-infant dyads residing in the 92 study electoral ward areas

Sample Size: 10,010 mother-infant dyads

Age Range: Mothers aged 16 to 44 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: This study was a randomized controlled trial of 425 obese pregnant women comparing 3 groups: (1) physical activity plus a dietary intervention (n = 142); (2) physical activity intervention (n = 142); and (3) a control group receiving standard care (n = 141). All participants had an initial dietary counseling session and were advised to limit their gestational weight gain to less than 5 kg. Physical activity intervention included encouragement to increase physical activity, aiming at a daily step count of 11,000, monitored by pedometer assessment on 7 consecutive days every 4 weeks. Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet. Instruction was given by a dietician every 2 weeks.

Intervention Results: The study was completed by 389 patients (92%). Median values of GWG (ranges) were lower in each of the intervention groups (PA plus D, 8.6 [-9.6 to 34.1] kg, and group PA, 9.4 [-3.4 to 28.2] kg) compared with the control group (10.9 [-4.4 to 28.7] kg [PA+D vs C]; P = .01; PA vs C; P = .042). No significant difference was found between the 2 intervention groups. In a multivariate analysis, physical activity intervention decreased GWG by a mean of 1.38 kg (P = .040). The Institute of Medicine's recommendations for GWG were more frequently followed in the intervention groups.

Conclusion: Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women.

Setting: Hvidovre Hospital, University of Copenhagen

Population of Focus: Obese pregnant women with singleton gestations (both nulliparous and multiparous)

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT_CONSUMER, ,

Intervention Description: Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services.

Intervention Results: Changes in prepost survey assessment of participants’ nutrition literacy and eating behaviors; changes in prepost survey assessment of participants’ breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment).

Conclusion: Process evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Continuity of Care (Caseload), Enabling Services, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER, PARENT_FAMILY

Intervention Description: To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors.

Intervention Results: A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors

Conclusion: Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Adult-led Support/Counseling/Remediation, YOUTH, PATIENT_CONSUMER, Feedback

Intervention Description: This study assessed the effect of Project Zero Exposure-an intervention program designed to help parents protect children from TSE-on children's exposure.

Intervention Results: Most enrolled families completed the trial (IG: 98.6%[68/69], RCG: 97.1%[68/70]). Log hair nicotine (LHN [ng/mg]) decreased in both the IG (Baseline: -1.78 ± 1.91, Follow-up: -2.82 ± 1.87, p = .003) and RCG (Baseline: -1.79 ± 1.54, Follow-up: -2.85 ± 1.73, p = .002), but did not differ between groups at study end (p = .635). Three of five parentally-reported outcomes showed improvement over time in the IG, and one in the RCG. Among IG participants, 90% found hair nicotine feedback useful.

Conclusion: No difference between the intervention and control groups was found on the objective biomarker, LHN. Child TSE decreased during the trial in intervention and control groups. Trial participation, which included hair nicotine monitoring, may have contributed to decreasing exposure in both groups. Concurrent control group improvements may partially explain lack of proven intervention benefit. Biomarker monitoring warrants further investigation for reduction of child TSE.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Peer Counselor

Intervention Description: To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention.

Intervention Results: Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding supp

Conclusion: Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays.

Intervention Results: 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)].

Conclusion: Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Intensive Therapy, PATIENT_CONSUMER, Psychoeducation, HOSPITAL, Hospital Laborist

Intervention Description: To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.

Intervention Results: Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).

Conclusion: To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.

Study Design: RCT

Setting: 1 maternity unit

Population of Focus: Nulliparous women with a measured fear of childbirth who gave birth after enrollment at antenatal clinics between October 2007 and August 20095

Data Source: Not specified

Sample Size: Total (n=371) Intervention (n=131) Control (n=240)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assistance in Making Dental Appointment, PATIENT_CONSUMER

Intervention Description: We investigated self-reported dental care referral and self-reported dental care attendance among a group of 298 low-income, largely racial-ethnic minority pregnant women attending two suburban prenatal care clinics that had integrated dental care referrals into their prenatal care according to these guidelines.

Intervention Results: Among those women who were eligible for a dental care referral (those who reported having dental symptoms, and those not having a recent dental visit), we found that 73.0% reported that they had indeed been referred for dental care by their prenatal provider, while the remaining women reported either no referral (23.5%, n = 67) or were not sure whether they had been referred (3.5%, n = 10). Among those who reported a dental care referral, 67.3% (n = 140) reported that they saw a dentist during their pregnancy, while of those who reported no dental care referral only 35.1% (n = 27) reported a dental visit (Chi-Sq. = 24.1, df = 1, p < 0.001). Having received a dental referral was a significant predictor of reporting a dental visit during pregnancy, with women who received a referral being 4.6 times more likely to report a dental visit during pregnancy compared to those women who did not report a referral.

Conclusion: These results demonstrate that vulnerable pregnant women referred for dental care by their prenatal provider will indeed seek and utilize dental care when offered. This dental referral program may serve as a model for improving the utilization of dental care among this population.

Intervention Components (click on component to see a list of all articles that use that intervention): Intensive Therapy, PATIENT/CONSUMER, PATIENT_CONSUMER

Intervention Description: To compare intensive and conventional therapy for severe fear of childbirth.

Intervention Results: Birth-related concerns decreased in the intensive therapy group but increased in the conventional therapy group (linear interaction between the group and birth-concerns P =.022). Labor was shorter in the intensive therapy group (mean +/- standard deviation 6.8 +/- 3.8 hours) compared with the conventional group (8.5 +/- 4.8 hours, P =.039). After intervention, 62% of those originally requesting a cesarean (n = 117) chose to deliver vaginally, equally in both groups. Cesarean was more frequent for those who refused to fill in the questionnaires than for those who completed them (57% compared with 27%, P =.001). In the log-linear model, parous women who had conventional therapy and refused to fill in the questionnaires chose a cesarean more often than expected (standardized residual 2.54, P =.011). There were no differences between groups in satisfaction with childbirth or in puerperal depression.

Conclusion: Both kinds of therapy reduced unnecessary cesareans, more so in nulliparous and well-motivated women. With intensive therapy, pregnancy- and birth-related anxiety and concerns were reduced, and labors were shorter.

Study Design: RCT

Setting: 1 university hospital

Population of Focus: Nulliparous women with a measured fear of childbirth who gave birth after enrollment between August 1996 and July 19992,6

Data Source: Not specified

Sample Size: Total (n=90) Intervention (n=44) Control (n=46)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Outreach (Provider), Diet/Exercise, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The NFFD trial was a population-based antenatal combined lifestyle intervention consisting of dietary counseling and supervised exercise classes, evaluated in a randomized controlled trial. Normal weight, overweight and obese participants were recruited by midwifes from eight healthcare clinics in the southern part of Norway, encompassing both cities and rural areas, between September 2009 and February 2013. The intervention group had access to a twice-weekly standardized exercise program. Classes were provided for groups at five different fitness centers, led by qualified instructors and consisted of 10 min of warm-up, 40 min of cardiovascular and strength exercises at moderate intensity, with emphasis on core and pelvic floor musculature, and finally 10 min of stretching. Exercise intensity was measured by ratings of perceived exertion set to 12–14 (somewhat hard) on the 6–20 Borg rating scale 18. Additionally, the participants were encouraged to undertake at least 30 min of cardio exercises at moderate intensity at least three times a week, in accordance with current physical activity recommendations 19. The dietary component of the intervention consisted of 10 dietary recommendations designed by the NFFD team

Intervention Results: The intervention group had a longer first stage of labor compared with the control group (293 ± 202 min vs. 257 ± 181 min, p = 0.030). No differences between the randomization groups were seen for time spent in second stage of labor, prolonged labor or mode of delivery. In the total sample, women with the highest physical activity level had lower odds ratio (OR) of acute cesarean delivery (OR 0.33, 95% CI 0.11-0.97, p = 0.044) than did those with the lowest physical activity-level.

Conclusion: A significantly longer first stage of labor was observed in the intervention group than in the control group. A high physical activity level in late pregnancy was associated with lower odds of acute cesarean delivery compared with a low physical activity level.

Setting: Southern Norway

Population of Focus: Healthy nulliparous women with a singleton pregnancy

Intervention Components (click on component to see a list of all articles that use that intervention): Telelactation, Technology-Based Support, PATIENT_CONSUMER

Intervention Description: To analyse the experience of Spanish paediatricians after the forced digitization of consultations due to the pandemic.

Intervention Results: 306 health professionals participated in the study Most of them agreed on the use of the internet and social networks during the pandemic, referring to mail or WhatsApp® as usual channels of communication with their patients' families. There was a great agreement among paediatricians that the evaluation of newborns after hospital discharge and establishing methodologies that allow childhood vaccination and the identification of subsidiary patients for face-to-face evaluation were necessary although the limitations of the lockdown. The idea that telephone and digital consultations have optimized the consultation time and that they will probably continue after the end of the pandemic was generally accepted. No changes in adherence to breastfeeding or the start of complementary feeding were referred to, but an increase in the duration of breastfeeding and the appearance of frequent hoaxes in social networks concerning infant feeding were found.

Conclusion: It is necessary to analyse the impact of telemedicine in paediatric consultations during the pandemic to evaluate its effectiveness and quality to maintain it in routine paediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Partner-Level Intervention, Technology-Based Support, COMMUNITY, Social Supports, Individual Supports,

Intervention Description: Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. Mobile health (mHealth) interventions employing digital technologies provide a rapidly evolving means of engaging fathers and providing them with information and support to address their needs related to both breastfeeding and transitioning to fatherhood. The Parent Infant Feeding Initiative (PIFI) was a 4-arm, randomized controlled trial conducted in Perth, Australia. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The primary outcomes were duration of exclusive and any breastfeeding. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions.

Intervention Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

Conclusion: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

Study Design: RCT

Setting: Antenatal breastfeeding class/Online

Population of Focus: Couples from public and private hospitals in Perth, Australia

Sample Size: 1426 couples

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Psychoprophylaxis, Childbirth Education Classes, PATIENT_CONSUMER

Intervention Description: Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended.

Intervention Results: Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93–4.43).

Conclusion: Women who attended psychoprophylaxis couple-based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Peer Counselor, Home Visits, PATIENT_CONSUMER

Intervention Description: To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF).

Intervention Results: The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6 months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80–7.07).

Conclusion: Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Intervention Components (click on component to see a list of all articles that use that intervention): Online Material/Education/Blogging, , PATIENT_CONSUMER, PARENT_FAMILY, Training (Parent/Family)

Intervention Description: This study examined effective strategies to communicate with parent smokers about the risks of secondhand smoke (SHS) exposure to children.

Intervention Results: Parent smokers who viewed either message recommendation reported greater harm perceptions (p <.001), self-efficacy (p <.001), and help-seeking intentions (p <.05) than the no-message control group. Cessation+exposure reduction recommendations elicited greater quit intentions than the no-message control (p <.05). Compared to text-only, videos elicited greater reduce-exposure intentions (p <.05) and interpersonal communication intentions (p <.05). Only videos elicited greater quit intentions (p <.01) and help-seeking intentions (p <.01) than the no-message control.

Conclusion: Communication about this topic can be optimized by recommending both cessation and exposure-reduction behaviors (versus cessation only), and by using videos (versus traditional print/text-based materials).

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PATIENT_CONSUMER

Intervention Description: The objective of this study was to examine the associations between attendance at childbirth education classes and maternal characteristics (age, income, educational level, single parent status), maternal psychological states (fear of birth, anxiety), rates of obstetric interventions, and breastfeeding initiation.

Intervention Results: Older, more educated, and nulliparous women were more likely to attend childbirth education classes than younger, less educated, and multiparous women. Attending prenatal education classes was associated with higher rates of vaginal births among women in the study sample. Rates of labor induction and augmentation and use of epidural anesthesia were not significantly associated with attendance at childbirth education classes.

Conclusion: Future studies might explore the effect of specialized education programs on rates of interventions during labor and mode of birth.

Study Design: Prospective cohort

Setting: Perinatal Services British Columbia data

Population of Focus: Nulliparous women who gave birth after prenatal survey completion between May 2005 and July 20072

Data Source: Not specified

Sample Size: Total (n=372) Intervention (n=311) Control (n=61)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Adult-led Support/Counseling/Remediation, PATIENT_CONSUMER, YOUTH, Incentives

Intervention Description: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit.

Intervention Results: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05).

Conclusion: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families.

Intervention Components (click on component to see a list of all articles that use that intervention): Enabling Services, Patient-Centered Medical Home, Expert Support (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To compare perspectives of caregivers of children with autism receiving care at the Neurobehavior Healthy Outcomes Medical Excellence (HOME) Program, an interdisciplinary clinic that provides primary care and behavioral/mental health services for patients with autism and other developmental disabilities, with those responding to the 2016 National Survey of Children’s Health (NSCH). We focused on ratings related to shared decision making, care coordination, family-centered care, and care within a medical home.

Intervention Results: Compared with the NSCH cohort (n=1,151), children enrolled in HOME (n=129) were older, more often female, had severe autism, and had co-occurring intellectual disability. Caregivers perceived that children receiving care within HOME more often received family-centered, coordinated care within a medical home compared with a national sample of children with autism. HOME enrollees also reported increased access to behavioral treatments and adult transition services with less financial burden compared to the national sample.

Conclusion: An interdisciplinary clinic model may best serve children with autism, especially those with higher severity symptoms and co-occurring conditions.

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), Adult-led Support/Counseling/Remediation, YOUTH, PATIENT_CONSUMER

Intervention Description: The Tobacco Dependence Program was developed to help reduce first-, second-, and thirdhand smoke exposure to our patients while they are in the hospital.

Intervention Results: As of March 2019, we enrolled 138 participants, 5% were in-patients. Fifty-five percent had children who were critically ill and in the ICU: pediatric ICU/progressive care unit (PCU) 28%, neonatal ICU 19%, cardiac ICU (CICU) 9%. The ethnicity of the participants was predominately white (56%), followed by African American (33%), Hispanic (12%), and Asian (<1%). Fifty-six percent of the participants were female. Fifty-nine percent of the participants began smoking between the ages of 12 and 18 y, 21% began between the ages of 18 and 25 y, 9% began before the age of 12 y, and 7% between the ages of 25 and 35 y. Fifty percent of the survey respondents stated that they were able to quit before discharge.

Conclusion: The Tobacco Dependence Program offers support to families as they begin the cessation process and provide the tools to continue a smoke-free lifestyle after discharge. The program is feasible and welcomed to assist patients and families in this process.

Intervention Components (click on component to see a list of all articles that use that intervention): Incentives, , PATIENT_CONSUMER

Intervention Description: To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services.

Intervention Results: From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born.

Conclusion: The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: A cohort study with a historical control was carried out with an exposed group, defined as women receiving a letter for recall in the week of November 21–27, 2013, and a non-exposed, control arm of women who did not receive the letter but who would have been eligible for correspondence in the same time period in 2012.

Intervention Results: The study population comprised 5182 women in the exposed group and 4223 women in the non-exposed group. Women receiving the letter were more likely to return to screening, with an aOR of 1.82 (95% CI 1.66–1.99). Other significant factors included being registered with a Patient Enrolment Model family physician and having a series of prior Pap tests in the past screening history.

Conclusion: A correspondence program benefits the retention of women in organized cervical screening programs.

Setting: Organized cervical screening program in Ontario

Population of Focus: Women ages 21-64 who had not received a pap test in the past 2.9 years

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Home Visits, Other Education, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.

Intervention Results: Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation.

Conclusion: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families’ medication administration practices and anticipate social needs after paediatric discharge.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Lactation Consultant, Other Education, Technology-Based Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice),

Intervention Description: Telelactation is one tool that can be leveraged to increase access to International Board Certified Lactation Consultants (IBCLCs) in rural settings. Telelactation services connect breastfeeding women to remotely located IBCLCs through audio-visual technology. The Telehealth for Mothers to Improve Lactation Confidence (Tele-MILC) randomized controlled trial evaluated the feasbility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural mothers. Participants randomized to the telelactation arm were given an orientation to Pacify Health's telelactation app by hospital nurses. The nurses showed participants how to download the app on a personal device (smartphone or tablet), provided a coupon code for free, umlimited video calls, and encouraged participants to conduct a test call on their own device or on a demonstration device. After the orientation, participants could request umlimited, on-demand video calls with IBCLCs through the app for as long as they desired. The app used in the trial aimed to provide video calls within seconds of a visit request by a mother. The app is also HIPAA-compliant, and the telelactation services it provides involves a large network of geographically dispersed IBCLCs available to take video calls 24 hours a day.

Intervention Results: Among participants in the telelactation arm, 50% (47/94) reported participating in video calls. At 12 weeks, 71% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the ITT model (3% difference, P = .73), whereas 73% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the IV model (5% difference, P = .74). Among participants who were still breastfeeding at 12 weeks, 51% participants in the telelactation arm were breastfeeding exclusively versus 46% of control participants in the ITT model (5% difference, P = .47), whereas 56% of participants in the telelactation arm were breastfeeding exclusively versus 45% of control participants in the IV model (11% difference, P = .48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant.

Conclusion: This trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413.

Study Design: RCT

Setting: Critical Access Hospital in North-Central PA/Online

Population of Focus: Postpartum women who had initiated breastfeeding and planned to contine after hospital discharge

Sample Size: 203 women (102 for intervention and 101 for control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Telephone Support, Partner-Level Intervention, Professional Support,

Intervention Description: The study examines the effectiveness of a comprehensive, evidence-based, professional support intervention for breastfeeding that was implemented in the Netherlands: the Breastfeeding Support Program (BSP). The BSP tries to increase the proportion of mothers who breastfeed exclusively for six months or longer by positively influencing 1) the mother's attitude towards breastfeeding (by focusing on the positive effects of exclusive breastfeeding for 6 months or longer for mother and child), 2) the subjective norm (by explicitly involving the father and by forming a reliable source of support and positive messages about breastfeeding throughout the program), and 3) the mother's perceived behavioral control (by providing information, encouragement, and practical support to improve breastfeeding skills). The BSP combines both education and support, extends from pregnancy to the postnatal period, and uses a protocolled series of six individual consults delivered by an IBCLC. The sixth and final consult is held 10 weeks after delivery by telpehone and focuses on further support for returning to work.

Intervention Results: The effect of the BSP on survival rates for any and exclusive breastfeeding were significant while controlling for differences between the two groups at baseline (respectively HR = 0.34, p < .001 [95% CI = 0.18–0.61] and HR = 0.46, p < .001 [95% CI = 0.29–0.72]). Among mothers in the BSP group there was on average 66% less risk of cessation of any breastfeeding and on average 54% less risk of cessation of exclusive breastfeeding at any point in time compared to those in the control group.

Conclusion: The BSP appears to be an effective means to delay cessation of any and exclusive breastfeeding cessation and therefore to increase breastfeeding duration and exclusivity. This is an important finding, because earlier cessation of breastfeeding than desired is a common problem in many countries. Future research into the effectiveness of the BSP could consider random assignment to conditions and test the effectiveness of the intervention in other populations to investigate further whether wide-scale implementation of this intervention could be useful to promote breastfeeding.

Study Design: Quasi-experimental study

Setting: Breastfeeding Support Program in the Netherlands

Population of Focus: Pregnant women who were planning to breastfeed and who made a personal decision to enroll in the BSP

Sample Size: 138 women (66 mothers in the intervention group and 72 mothers in the control group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: 114 obese women (BMI ≥30 kg/m2) between 7–21 weeks’ gestation were randomized to receive the intervention (n=56) or usual care control conditions (n=58). The intervention program included a combination of dietary and exercise recommendations, along with the use of behavioral self-management techniques to help participants initiate and maintain behavior changes. A study dietician advised intervention participants to follow an energy reduced eating plan, based on Dietary Approaches to Stop Hypertension (DASH) -- without sodium restriction. The intervention leaders encouraged participants to accumulate at least 30 minutes of moderate physical activity per day in the absence of medical or obstetrical complications, a goal consistent with the recommendations of the American College of Obstetricians and Gynecologists (ACOG). They gave each intervention participant a pedometer, and encouraged them to record their physical activity in their daily food and activity records. 

Intervention Results: Intervention participants gained less weight from randomization to 34 weeks gestation (5.0 vs. 8.4 kg, mean difference = -3.4 kg, 95% CI [-5.1-1.8]), and from randomization to 2 weeks postpartum (-2.6 vs. +1.2 kg, mean difference = -3.8 kg, 95% CI [-5.9-1.7]). They also had a lower proportion of LGA babies (9 vs. 26%, odds ratio = 0.28, 95% CI [0.09-0.84]).

Conclusion: The intervention resulted in lower GWG and lower prevalence of LGA newborns.

Setting: Prenatal care unit at Kaiser Permanente, Northwest (KPNW)

Population of Focus: Nulliparous and multiparous pregnant women with a BMI ≥30

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Diet/Exercise

Intervention Description: The intervention consisted of two major components: dietary counseling and physical activity. Dietary counseling was performed by trained dietitians on four separate occasions, at 15, 20, 28, and 35 weeks’ gestation. The aim was to limit GWG to 5 kg. Women in the intervention group were encouraged to be moderately physically active 30–60 min daily and were equipped with a pedometer to motivate and improve daily activity. Women in this group also had free full-time membership in a fitness center for 6 months, where they had closed training classes with physiotherapists for 1 h each week. Training consisted of aerobic (low-step), training with light weights and elastic bands, and balance exercises. After physical training, the women were grouped 4–6 times in pregnancy with the physiotherapist using coaching-inspired methods for improving participants’ integration of physical activities in pregnancy and daily life. The women in the control group received the same initial information about the purpose and content of the study, including access to a website with advice about dietary habits and physical activities in pregnancy, but no additional intervention.

Intervention Results: A total of 360 obese pregnant women were included, and 304 (84%) were followed up until delivery. The intervention group had a significantly lower median (range) GWG compared with the control group of 7.0 (4.7-10.6) vs. 8.6 kg (5.7-11.5; P = 0.01). The Institute of Medicine (IOM) recommendations on GWG were exceeded in 35.4% of women in the intervention group compared with 46.6% in the control group (P = 0.058). Overall, the obstetric outcomes between the two groups were not significantly different.

Conclusion: Lifestyle intervention in pregnancy resulted in limited GWG in obese pregnant women. Overall obstetric outcomes were similar in the two groups. Lifestyle intervention resulted in a higher adherence to the IOM weight gain recommendations; however, a significant number of women still exceeded the upper threshold.

Setting: Two university hospitals in Denmark

Population of Focus: Obese pregnant women with singleton gestations (both nulliparous and multiparous)

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Educational Material, Group Education, Incentives,

Intervention Description: The AMEN (originally "Avondale Moms Empowered to Nurse;" remaned to "All Moms Empowered to Nurse") project was the first Peer-to-Peer (Mom-to-Mom) breastfeeding education and support project in Avondale, a neighborhood in Hamilton County, Ohio. AMEN was designed to provide Peer-to-Peer (Mom-to-Mom) breastfeeding education and support, specifically for African American mothers living in neighborhoods of poverty, to increase breastfeeding initiation and duration. The peer support group typically met one to two times per month with the provision of childcare, transportation, refreshments, and grocery gift card incentives. Group activities included sharing of a breastfeeding topic of interest by Champion moms, various interactive activities (e.g., breastfeeding Jeopardy), and faciliated sharing by attendees, in addition to special guest presentations. With the COVID-19 pandemic, the group pivoted to the virtual world (Zoom) allowing even more mothers to join.

Intervention Results: Since May 2017, 67 AMEN support meetings have included 158 participants, with average attendance of 10 (range 5–19) per meeting. In addition to 8 Champions, 110 moms have attended, including 24% expecting mothers. Additional attendees include 13 family support persons, 23 guest speakers, and 12 from community outreach programs. Qualitative feedback from participants has been uniformly positive. Breastfeeding initiation rates have increased 12% in the initial neighborhood.

Conclusion: Harnessing strength within the local community, Champion Breastfeeding Moms have successfully launched AMEN breastfeeding support groups in under-resourced African American urban neighborhoods, helping more mothers reach their breastfeeding goals.

Study Design: Mixed methods

Setting: Home visitation program, Every Child Succeeds, at Carmel Presbyterian Church in partnership with the Cincinnati Children's Hospital Medical Center in the Avondale neighborhood

Population of Focus: Participants in the AMEN peer support program

Sample Size: 67 support meetings with a total of 158 participants (8 champions, 110 mothers, 13 family support persons, 23 guest speakers, and 12 from community outreach programs)

Age Range: Not reported

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Incentives,

Intervention Description: Incentives that are immediately delivered contingent on verified occurence of a specific observable behavior have been effective in encouraging healthy behavior change. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with WIC services only among low-income, urban Puerto Rican mothers.

Intervention Results: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits).

Conclusion: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.

Study Design: Randomized, 2-arm parallel-group design

Setting: WIC program

Population of Focus: WIC-enrolled Puerto Rican mothers

Sample Size: 36 women

Age Range: Mothers 18-29 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, Educational Material, PATIENT_CONSUMER

Intervention Description: To examine the critical role that an academic-clinical partnership played in the development and refinement of a family management intervention in the Neonatal Intensive Care Unit (NICU).

Intervention Results: During Council meetings, the clinical-academic nurse, Director of Family-Integrated Care, and Council members identified the need for a family management intervention, and worked together to develop and refine PREEMIE PROGRESS. Mothers found the intervention had numerous strengths, and perceived a benefit knowing they helped future parents.

Conclusion: This work was only possible by leveraging both the university’s technology/research resources and the clinical expertise of the NICU staff and Parent Partnership Council. Co-authored presentations, publications, and grant funding continued this NICU’s legacy in family-centered care and helped shape the clinical-academic nurse’s career.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, HEALTH_CARE_PROVIDER_PRACTICE, Midwifery, Labor Support

Intervention Description: A hospital in Belgium introduced "the cocoon," an alongside midwifery-led care unit. Low-risk pregnant women had the option of choosing the midwifery pathway or attending the traditional care pathway. Patients who chose the Cocoon pathway (62.2 percent nulliparous and 37.8% multiparous) had their pregnancy followed up almost exclusively by midwives, and their care was reviewed by a gynecologist at least twice during their pregnancy. The visits at the Cocoon lasted 45 minutes instead of the standard 20 minutes in the “classic” clinic. Women and their birth partners were encouraged to attend classes provided by midwives from the Cocoon and were given the opportunity to participate in a maximum of seven classes, six of which were group classes.

Intervention Results: In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25-0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30-0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09-0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17-0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively.

Conclusion: Women planning their births in the midwifery-led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery-led care pathways in other hospitals in Belgium.

Setting: Alongside midwifery‐led unit within a Belgian hospital

Population of Focus: Nulliparous and multiparous women with low-risk pregnancies

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, PATIENT_CONSUMER, ,

Intervention Description: This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information.

Intervention Results: While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1–80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level.

Conclusion: This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Pharmacotherapy (Nicotine), Referrals, PATIENT_CONSUMER

Intervention Description: We tested the efficacy of a smoking cessation intervention for parents of hospitalized children.

Intervention Results: Of 1641 eligible families approached, 252 were randomized (15%); 149 families had follow-up data at 12 months (59%). In the adjusted analysis, there was no difference between the groups in smoke free home rules, or child cotinine level; in an intention-to-treat analysis, 15% in the intervention group versus 8% of controls reported quit (p=0.07).

Conclusion: A smoking cessation intervention can be delivered to parents of hospitalized children. While hospitalization provides an opportunity to help parents quit smoking, more efficient and effective engagement strategies are needed to optimize tobacco control success.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: Many women do not have adequate and consistent social support to help them deal with breastfeeding difficulties at home after childbirth. Millennial women (those born between 1980 and 1999) have a significant presence online, making internet-based sources of breastfeeding support a potentially far-reaching, cost-effective, and convenient innovation. Social media platforms (e.g., Facebook, YouTube, Twitter, LinkedIn, Pinterest, GooglePlus+, Tumblr, and Instagram) are internet-based applications that enable the creation and exchange of user-generated content that may provide an avenue of social support. Social media breastfeeding support groups (SMBSGs) provide a cost-efficient, immediate approach to gaining social support and education from vast populations with various sociodemographics. Using 17 SMBSGs, the study team explored the variables that lead to sustained, exclusive breastfeeding to 6 months for breastfeeding millennial women who follow SMBSGs.

Intervention Results: Using structural equation modeling, I examined relationships among personal factors; competing situational demands; social support; and confidence in, knowledge of, attitude toward, and sustainability of breastfeeding. Age, education, and competing work and family demands were all predictive of social support. Breastfeeding social support had a direct effect on participants’ breastfeeding confidence, knowledge, and attitudes (F = 4.96, R2 = .07, p < .002). Furthermore, within SMBSGs, exclusive breastfeeding to 6 months was reported to be three times (66%) greater than the U.S. national average (22%).

Conclusion: Interventions aimed at providing women with resources to gain breastfeeding social support, such as SMBSGs, may be vehicles to improve women’s confidence, knowledge, and attitudes and, therefore, increase the potential for exclusive breastfeeding to 6 months.

Study Design: Repeated measures, longitudinal, mixed-methods

Setting: Online social media support groups across 21 countries

Population of Focus: Convenience sample of exclusively breastfeeding millenial women who followed at least one of 17 social media breastfeeding support groups

Sample Size: 241 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Lactation Consultant, Other Education, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice),

Intervention Description: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. The study intervention implemented routine LC/PCP visits for families at their first newborn visit to the FQHC following hospital discharge. A typical team-based visit was scheduled for 40 minutes with the RN/LC present for the entire visit and the PCP joining for about 10 minutes to examine the infant and coordinate the plan of care. The remaining 30 minutes was dedicated to lactation support, including addressing latch, milk supply, decreasing maternal pain, and breastfeeding anticipatory guidance.

Intervention Results: Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were “latch instruction” (60%), “breastfeeding questions answered” (80%) and “learning about massage and hand expression” (50%).

Conclusion: Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.

Study Design: Retrospective chart review

Setting: Federally Qualified Health Center in Cleveland, OH

Population of Focus: Women and infants receiving care at a Federally Qualified Health Center

Sample Size: Pre (n=197 women) and post (n=245 women)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Technology-Based Support, PATIENT_CONSUMER

Intervention Description: In response to the cessation of in-person prenatal education services during the COVID-19 pandemic, we adapted an evidence-based curriculum to a live virtual format entitled Ready, Set, Baby Live COVID-19 Edition (RSB Live).

Intervention Results: In a sample of 146 pregnant people, participation in RSB Live was associated with high levels of knowledge about the benefits of breastfeeding, early infant hunger cues, and recommended maternity care practices, as well as high levels of satisfaction with adaptations to the session’s content and virtual delivery. Participation was also associated with a significant increase in prenatal breastfeeding intention, a known predictor of breastfeeding outcomes.

Conclusion: This study supports live, virtual education with a standardized curriculum as an effective and acceptable means of providing prenatal education.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Intensive Therapy

Intervention Description: The aim of this study was to analyse the risk of obstetrical interventions and complications among nulliparous women, in spontaneous labour at term with one foetus in cephalic presentation (Robson 12), in sensory delivery rooms with spectral light settings compared with the light settings in the standard delivery rooms. The primary outcomes were the use of additional oxytocin during labour and the risk of caesarean delivery. In this observational study of 789 women, 313 gave birth in a sensory room and 476 in a standard delivery room. Sensory delivery rooms offer programmable calming lights (Fig. 1) with low irradiance, restful blurred pictures displayed on a wall-sized big screen, and sound effects.

Intervention Results: The risk of a caesarean delivery was significantly decreased when giving birth in a sensory room compared with a standard delivery room (OR, multiple adjusted: 0.44; 95% CI 0.22–0.87); furthermore, the use of oxytocin infusion was also reduced (OR, multiple adjusted: 0.71; 95% CI 0.50–1.03).

Conclusion: This observational cohort study suggests that giving birth in a sensory delivery room could lower the risk of caesarean delivery, potentially reducing the number of such deliveries by one for every 23 patients.

Setting: Nulliparous, term pregnant women having a single baby with a cephalic presentation who were in spontaneous labour

Population of Focus: North Zealand Hospital, Hillerød

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, PATIENT_CONSUMER, Educational Material

Intervention Description: We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm).

Intervention Results: Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001).

Conclusion: Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Home Visits,

Intervention Description: RCT to determine the effect of breastfeeding training on mothers’ knowledge, behaviors, and exclusive breastfeeding for 6 months. The training group received breastfeeding education during the prenatal and postnatal periods from the researcher. Besides the breastfeeding training that the pregnant women in the control group were provided by the hospital, they received education in the prenatal period about modern family planning methods. Prenatal training was provided to each pregnant woman in two lessons in a room allocated for training within the hospital. Each group consisted of 8-14 participants. Both groups were monitored through home visits in the 1st and 24th weeks postpartum. Postnatal training was provided within the first 24 h postpartum. The training lasted for at least 30 minutes and focused mostly on breastfeeding problems and breastfeeding techniques.

Intervention Results: The difference between the number of correct answers in pre- and posttest was higher in the training group (four questions) than in the control group (two questions) (p < .001). The number of mothers exclusively breastfeeding for 6 months was significantly higher in the training group (26.5%) than in the control group (3.3%) (p = .015). The median of the exclusive breastfeeding period was longer in the training group (5 months) than in the control group (4 months) (p = .013).

Conclusion: Training and supporting pregnant women and breastfeeding mothers on breastfeeding increased their knowledge, the period of exclusive breastfeeding, and the rate of 6-month exclusive breastfeeding.

Study Design: RCT

Setting: Outpatient OB/GYN clinics of a private baby-friendly hospital in the city center of Kayseri Province, Turkey

Population of Focus: Pregnant women in their 2nd or 3rd trimester attending the OB/GYN polyclinics of a baby-friendly hospital

Sample Size: 120 women (60 for training and 60 in the control groups)

Age Range: Women 20 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Lactation Consultant, PATIENT_CONSUMER, ,

Intervention Description: The objective of this study is to examine associations between state-level breastfeeding support and breastfeeding practices, controlling for women’s status, in the U.S.

Intervention Results: After controlling for women’s status, only IBCLCs were positively associated with rates of exclusive breastfeeding at 6 months and continued breastfeeding at 12 months. For every additional IBCLC per 1000 live births, the rate of exclusive breastfeeding at 6 months increased by 5 percent (95% CI 1.03, 1.07) and the rate of breastfeeding at 12 months increased by 4 percent (95% CI 1.02, 1.06). Political participation, poverty, and employment and earnings were associated with breastfeeding practices, indicating a relationship between women’s political and economic status and their breastfeeding practices in the U.S.

Conclusion: Given the influence of women’s status, increasing the number of IBCLCs may improve breastfeeding practices.