Established Evidence Results

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): Health Insurance Coverage, Access, Educational Material, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Refugees with interrupted healthcare coverage were more likely to have an inadequate USC. Refugees who were young (age 10-19), resettled into the western region of the US, and highly educated were less likely to have an inadequate USC. Refugees with an education level higher than secondary had a significantly lower likelihood of having a severely deficient USC, while refugees with interrupted healthcare were more than twice as likely to have a severely deficient USC.

Conclusion: Considering these results alongside our previous healthcare coverage findings provides a more comprehensive understanding of sociodemographic predictors of poor healthcare access among refugees resettled into the US. This improved understanding has the potential to assist early refugee contacts toward more effective healthcare resource allocation and aid policymakers attempting to improve programs linked to refugee healthcare access.

Study Design: We used multiple binary logistic regression methods to identify sociodemographic predictors of inadequate USCs. In addition, we used multinomial logistic regression to further assess predictors of inadequate USCs with a particular focus on severely deficit USCs (i.e., emergency department dependence and USC absence).

Setting: 2016 Annual Survey of Refugees; United States

Population of Focus: Refugees

Sample Size: 4037

Age Range: 16-75

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

Intervention Description: We conducted a prospective cohort analysis of a population of 4530 CMC enrolled in a learning collaborative designed to improve care for CMC ages 0 to 21 years identified using 3M Clinical Risk Group categories 5b through 9. The primary outcome was total per-member per-year standardized spending; secondary outcomes included inpatient and emergency department (ED) spending and use. We used a 1:1 propensity score match to compare enrolled patients to eligible nonenrolled patients and statistical process control methods to analyze spending and usage rates.

Intervention Results: Comparison with the matched group showed a 4.6% (95% confidence interval [CI]: 1.9%-7.3%) decrease in total per-member per-year spending (P < .001), a 7.7% (95% CI: 1.2%-13.5%) decrease in inpatient spending (P = .04), and an 11.6% (95% CI: 3.9%-18.4%) decrease in ED spending (P = .04). Statistical process control analysis showed a decrease in hospitalization rate and ED visits.

Conclusion: CMC enrolled in a learning collaborative showed significant decreases in total spending and a significant decrease in the number of hospitalizations and ED visits. Additional research is needed to determine more specific causal factors for the results and if these results are sustainable over time and replicable in other settings.

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

Intervention Description: Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n = 151), the AMIGAS program without the video (n = 154), the AMIGAS program without the flip chart (n = 155), and a usual care control group (n = 153). Six months after enrollment, women were surveyed and reported whether or not they had been screened.

Intervention Results: Women in any of the intervention arms were statistically significantly more likely to report being screened than those in the usual care group in both an intent-to-treat analysis and a per-protocol analysis. In the intent-to-treat analysis, 25% of women in the control group and 52% in the full AMIGAS program group reported having had Pap tests (P < .001); in the per-protocol analysis, the percentages were 29% and 62%, respectively (P < .001).

Conclusion: AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention.

Study Design: RCT: pretest-posttest

Setting: El Paso, TX; Houston, TX; and Yakima Valley, WA

Population of Focus: Mexican women with no Pap smear reported in the past 3 years

Data Source: Self-report and validated through medical records review

Sample Size: Intent-to-Treat Analysis (n=613) Intervention Group 1 (n=151); Intervention Group 2 (n=154); Intervention Group 3 (n=155); Control (n=153) Per-Protocol Analysis (n=513) Intervention Group 1 (n=128); Intervention Group 2 (n=125); Intervention Group 3 (n=127); Control (n=133)

Age Range: ≥21

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

Intervention Description: A case study shows us how group prenatal care may be one viable vehicle through which to affect this change. Group prenatal care is one of the few interventions shown to improve pregnancy outcomes for black women.

Intervention Results: The intervention increased the likelihood of diagnosing the unmet mental health needs, but the available mental health referral network for uninsured and underinsured patients in St. Louis was inadequate. Therefore, the collaborative identified a mental health referral network to care for pa- tients whose mental health needs excee- ded the ability of obstetrical clinicians to address in the group space

Conclusion: The underlying mechanism through which group prenatal care works may be through increased quantity and quality of patient and practitioner time together and communication. We hypothesize that this, in turn, fosters greater opportunity for cross-cultural exposure and decreases clinician implicit bias, explicit bias, and racism, thus increasing the likelihood that practitioners advocate for systems-level changes that directly benefit patients and improve perinatal outcomes.

Study Design: Qualitative

Setting: Community-based

Population of Focus: Predominantly low-income, black women

Sample Size: Unknown

Age Range: Not disclosed

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

Intervention Description: In 2014, the University of Illinois Health and Health Sciences System initiated the Coordinated Healthcare for Complex Kids (CHECK) program. This comprehensive care coordination demonstration project aimed to provide services for children and young adults with chronic health conditions in Chicago insured by Medicaid. CHECK adopted a holistic approach, addressing social determinants of health, caregiver wellness, mental health, and chronic disease management. The program targeted individuals with diagnoses such as asthma, diabetes, sickle cell disease, seizure disorder, or prematurity, spanning from birth to age 25. Participants were enrolled in the traditional, fee-for-service state Medicaid program or a Medicaid managed care organization (MCO) in Illinois. CHECK offered various services, including care coordination by community health workers (CHWs), mental health services by professionals, and disease-specific health education. CHWs assessed individual and family needs, analyzing health care utilization patterns in the year before enrollment. The program operated from May 1, 2014, to April 30, 2017, with data collection conducted in May 2018, covering the 12 months before and after randomization. For further details, refer to Table 4: Intervention Descriptions in the Evidence Review.

Intervention Results: In this analysis of the Chicago-based CHECK program (a large care-coordination initiative for low-income children and youth with chronic health conditions), overall Medicaid expenditures and utilization decreased considerably during the first year of the CHECK program for both CHECK participants and the usual care group. Notably, expenditures did not increase among CHECK participants, which has been noted in other care coordination programs. The rate of inpatient and ED utilization decreased for both groups. The mean (SD) inpatient utilization before enrollment in CHECK was 63.0 (344.4) per 1000 PYs for the intervention group and 69.3 (370.9) per 1000 PYs for the usual care group, which decreased to 43.5 (297.2) per 1000 PYs and 47.8 (304.9) per 1000 PYs, respectively, after the intervention.

Conclusion: Medicaid expenditures and utilization patterns decreased similarly among participants who were enrolled in the CHECK program and those in the UC group. Among children and young adults with asthma and those considered medium and high risk, a comprehensive care coordination program indicated that it could decrease ED utilization.

Study Design: RCT

Setting: Community (Coordinated Healthcare for Complex Kids (CHECK) program; Illinois Medicaid)

Population of Focus: Children with chronic diseases

Sample Size: The study involved a total of 6,245 children and young adults, with 3,119 individuals in the control group and 3,126 individuals in the intervention group.

Age Range: The study included children younger than 1 year old and youth older than 18 years. The mean age of the participants was 11.3 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Educational Material, Group Education, Home Visits, Telephone Support

Intervention Description: Evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants.

Intervention Results: Significant differences in the percentage of women initiating breastfeeding in the video (50%), peer counselor (62%), and video + peer counselor (52%) groups vs control group (26%)

Conclusion: Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.

Study Design: Cluster RCT

Setting: 4 WIC clinics in Baltimore, MD

Population of Focus: WIC eligible African American women starting prenatal care < 24 GA, with a singleton pregnancy, planning to keep the baby and stay in the clinic’s catchment area

Data Source: Mother self-report

Sample Size: Video (n=64) • Peer Counselor (n=55) • Video + Peer Counselor (n=66) • Control (n=57)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, Telephone Support, Educational Material, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study examined the effects of a parent–child interactive program on reducing children’s exposure to ETS at home and enhancing parents’ and children’s prevention strategies.

Intervention Results: The percentage of children with urine cotinine levels greater than or equal to 6ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents’ prevention of children’s ETS exposure and children’s ETS avoidance behavior from the baseline to the 20-week assessment.

Conclusion: This is a preliminary study design aimed at creating a program for reducing children’s ETS exposure at home. Further research to produce evidence supporting the application of the parent–child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs.

Study Design: Single-blind, two-group, repeated-measures clustered randomized controlled trial design

Setting: Community (schools)

Population of Focus: School-aged children’s reduction of SHSe

Data Source: Elementary schools were the unit of assignment

Sample Size: 75 parent and child dyads in 6 elementary schools (grades 3 to 6)

Age Range: Not specified

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

Intervention Description: The study describes a community-specific and culturally coherent approach to youth mental health services, emphasizing culturally relevant adjustments in the delivery of youth mental wellness services and related community wellness initiatives, with a focus on connections to culture and traditional skills, and strengthening support systems to improve access to mainstream mental healthcare when needed.

Intervention Results: The study highlights the adaptation of the ACCESS Open Minds framework to Inuit paradigms in Ulukhaktok and its potential as a sustainable prototype for delivering youth mental health services in Indigenous communities.

Conclusion: The conclusion emphasizes the need for easier access to specialized mental health services when needed in Indigenous communities.

Study Design: Community-specific and culturally coherent approach to youth mental health services

Setting: Ulukhaktok, Northwest Territories, Canada

Population of Focus: Indigenous youth in the Ulukhaktok community

Sample Size: Not explicitly mentioned in the provided abstract

Age Range: Age range: Primarily focused on youth under the age of 25, with a specific emphasis on adolescents

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

Intervention Description: The intervention consisted of breastfeeding education delivered by a trained counselor, along with incentive marketing using a truth or myth activity in a small group format, followed by instruction, discussion, and informational handouts. Specific incentives included an enhanced food package valued at over $50 per month and extended program eligibility for women who exclusively breastfed or did not receive formula. Additionally, mothers in the study who exclusively breastfed for at least 2 months were eligible for a $25 mall gift certificate. The control group received the standard prenatal education on the general benefits and barriers to breastfeeding, and clients in both groups were provided with educational materials and support.

Intervention Results: The results of the intervention showed mixed outcomes. While there was no significant difference in breastfeeding initiation rates between the intervention and control groups, the intervention group had a significantly higher percentage of women who exclusively breastfed (P=.025) and breastfed for a longer duration than the control group. The intervention also had a significant positive effect on breastfeeding knowledge and beliefs among participants. Although the intervention did not significantly impact total breastfeeding duration, the exclusive breastfeeding duration was significantly longer for the intervention group.

Conclusion: The study concluded that exposure to a single breastfeeding intervention with incentives had significant positive effects on exclusive breastfeeding rates and duration, as well as on breastfeeding attitudes and perceptions. The authors suggest that interventions plus incentives should be considered by dietitians and lactation educators to increase breastfeeding exclusivity and duration among WIC populations. However, the study had limitations, such as a high dropout rate in the intervention group, which may have led to confounding factors influencing the results.

Study Design: RCT

Setting: Western NY

Population of Focus: Women participating in WIC who spoke English, were pregnant, and HIV negative

Data Source: Mother self-report

Sample Size: Intervention (n=30/19)3 Control (n=30/29)

Age Range: Not specified

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 Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: Evaluate the effect of an educational intervention on four domains of health care utilization and cervical cancer prevention and screening in a Hispanic population.

Intervention Results: Educational interventions designed to meet the needs identified by the sample group led to an increase in HPV awareness throughout the entire population surveyed and an increase in health care service utilization and HPV vaccine acceptance for women living in the US for <5 years.

Conclusion: These tools should be promoted to reduce the cervical cancer burden on vulnerable populations.

Study Design: QE: pretest-posttest

Setting: Boston, MA

Population of Focus: Hispanic women in the Boston area

Data Source: Written survey in English or Spanish

Sample Size: Baseline (n=318) Follow-up (n=295)

Age Range: ≥18

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

Intervention Description: This study aimed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding.

Intervention Results: Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299).

Conclusion: In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.

Study Design: RCT

Setting: Royal Women’s Hospital in Melbourne

Population of Focus: Women who were public patients, having a first child, between 16- 24 weeks GA when recruited, and able to speak, read, and write English

Data Source: Mother self-report

Sample Size: Randomized • Practical Skills (n=327) • Attitudes (n=327) • Control (n=328) 6-Month Follow-Up • Practical Skills (n=297) • Attitudes (n=293) • Control (n=299)

Age Range: Not specified

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): 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, Enabling Services, Educational Material, Community-Based Group Education, Designated Clinic/Extended Hours, PROVIDER/PRACTICE

Intervention Description: This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community.

Intervention Results: Women in intervention community significantly more likely to be compliant with Pap smear guidelines than women in control community (X2=5.73. p=.02)

Conclusion: Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Oahu, HI

Population of Focus: Native Hawaiian women

Data Source: Telephone survey

Sample Size: Total (N=1,260) Analysis (n=678) Intervention (n=318); Control (n=360)

Age Range: ≥18

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

Intervention Description: The intervention in the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was the implementation of the CenteringPregnancy program in a public health setting . CenteringPregnancy is a group prenatal care model that integrates health assessment, interactive learning, and community building . The program consists of 10 two-hour sessions at routine prenatal care intervals from early second trimester through delivery, with groups consisting of 8-12 women . Physical assessments occur during the first 30 minutes behind a privacy screen, and the session's final 1.5 hours include facilitated discussions of topics within the CenteringPregnancy curriculum or of the groups' choosing . Patients are grouped by delivery month and are asked to calculate their gestational age, weigh themselves, and take their own blood pressures. These activities, along with education and group support, boost confidence and communication skills within healthcare settings, which is important for women with few patient-provider experiences . The SWHD provided group prenatal care 2 days per week at different Centering Healthcare Institute (CHI) accredited locations, with onsite Medicaid presumptive eligibility, transportation assistance, social service linkages, home visitation, nutrition assessments, and telehealth services . The program was implemented through a public-private partnership between the SWHD, local obstetricians and medical centers, and non-profit grant funders

Intervention Results: The study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" reported the following results: 1. Six hundred and six low-income women initiated prenatal care, with 55.4% self-identifying as non-Hispanic black and 36.4% as Hispanic. The median age of the women was 23 years, and nearly 69% initiated prenatal care in the first trimester . 2. Perinatal outcomes were examined among 338 singleton live births. The preterm birth rate (percentage of births < 37 weeks gestation at delivery) from 2010 to 2014 was 9.1%, and the low birth weight rate (percentage of births < 2500 g) was 8.9%. Additionally, nearly 77% of women initiated breastfeeding . 3. The study also assessed the attendance and participation in the CenteringPregnancy program, with 452 women enrolling and 369 attending at least three sessions . These results provide insights into the perinatal outcomes and program participation of low-income women in Southwest Georgia who received group prenatal care through the CenteringPregnancy program. The findings suggest that the program may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings .

Conclusion: concluded that the CenteringPregnancy program can be successfully implemented in a public health setting to improve perinatal outcomes for low-income women . The study found that the program was associated with a relatively low preterm birth rate and low birth weight rate, as well as a high rate of breastfeeding initiation . The study also identified several key lessons learned from the implementation of the program, including the importance of steadfast leadership, setting a start date and starting regardless of group size, and being prepared for painful disclosures . The study's findings suggest that group prenatal care may be an effective approach to improving perinatal outcomes for low-income women in low-resource settings, and that public-private partnerships can be an effective way to implement such programs .

Study Design: The study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" utilized a retrospective observational study design . The researchers reviewed prenatal and hospital medical records of patients who initiated prenatal care between October 2009 and October 2014 to assess the program's first 5-year perinatal outcomes . Descriptive analyses were conducted to examine the demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session . The study design allowed the researchers to evaluate the impact of the CenteringPregnancy program on perinatal outcomes for low-income women in Southwest Georgia. The retrospective observational study design enabled the researchers to analyze existing data to assess the effectiveness of the program in improving access to prenatal care and perinatal outcomes for medically underserved women in a low-resource setting.

Setting: The setting for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" is primarily focused on Southwest Georgia. The program was implemented in Georgia’s Southwest Public Health District (SWHD), which serves approximately 360,000 individuals across 14 counties . The specific locations within this district where the program was implemented include public health clinics, medical centers, and obstetrician practices in the Southwest Georgia region . The study's setting reflects a low-resource, medically underserved area, where the implementation of group prenatal care aimed to improve access to prenatal services and perinatal outcomes for low-income women . This setting is crucial for understanding the context in which the program was implemented and the population it aimed to serve.

Population of Focus: The target audience for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" includes: 1. **Public Health Professionals**: The findings of the study are relevant to public health professionals, including those involved in maternal and child health, community health, and healthcare administration. The study provides insights into the successful implementation of group prenatal care in a public health setting and offers lessons learned that can be valuable for public health practitioners 1. 2. **Healthcare Providers**: Obstetricians, gynecologists, midwives, and other healthcare providers involved in prenatal care may find the study's outcomes and lessons learned relevant to their practice. The study's focus on improving access to prenatal care and perinatal outcomes for medically underserved women can inform healthcare providers working in similar settings 1. 3. **Policy Makers and Funders**: The study's emphasis on public-private partnerships and the successful implementation of group prenatal care in a low-resource setting may be of interest to policy makers and funders involved in maternal and child health initiatives. The findings can inform decision-making related to funding and policy development aimed at improving prenatal care access and perinatal outcomes for underserved populations. 4. **Researchers and Academics**: Researchers and academics in the fields of public health, maternal and child health, and healthcare disparities may find the study's methodology and outcomes relevant to their research interests. The study contributes to the evidence base on the implementation of group prenatal care and its impact on perinatal outcomes in low-resource settings. By targeting these audiences, the study aims to disseminate its findings and lessons learned to professionals and stakeholders involved in improving prenatal care access and perinatal outcomes for medically underserved populations.

Sample Size: The sample size for the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was 606 low-income women who initiated prenatal care between October 2009 and October 2014 . Of these 606 women, 338 had singleton live births and were included in the analysis of perinatal outcomes . Additionally, 452 women enrolled in the CenteringPregnancy program, with 369 of these women attending at least three sessions . The study's sample size reflects the population of low-income women in Southwest Georgia who face limited access to prenatal care and disproportionately higher rates of adverse perinatal outcomes . While the sample size is relatively small, the study's findings provide valuable insights into the implementation of group prenatal care in a public health setting and its impact on perinatal outcomes for low-income women.

Age Range: The age range for the sample population in the study "Implementing Group Prenatal Care in Southwest Georgia Through Public–Private Partnerships" was 13 to 49 years . The median maternal age was 23 years, with an interquartile range (IQR) of 20 to 28 years . The age distribution of the sample population was as follows: - 21.0% of women were between 13 and 19 years old - 38.6% of women were between 20 and 24 years old - 21.6% of women were between 25 and 29 years old - 11.3% of women were between 30 and 34 years old - 7.5% of women were 35 years old or older The age range of the sample population is important to consider because maternal age can be a risk factor for adverse perinatal outcomes, such as preterm birth and low birth weight . The study's findings suggest that group prenatal care may be effective in improving perinatal outcomes for low-income women across a range of ages.

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

Intervention Description: The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013 in a collaborative-practice model (CPM). In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models.

Intervention Results: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01).

Conclusion: Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.

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): Community-Based Group Education, Prenatal Care Access,

Intervention Description: We linked birth certificates and Medicaid claims for women receiving group prenatal care in 18 healthcare practices and applied preferential-within cluster propensity score methods to identify a comparison group, accounting for the nested data structure by practice. We examined five standardized, claims-based outcomes: postpartum visit attendance; contraception within 3 days; and any contraception, long-acting reversible contraception (LARC), and permanent contraception within eight weeks. We assessed outcomes using logistic regression for two treatment levels: (1) any group attendance compared to no group attendance and (2) attendance at five or more group sessions to at least five prenatal care visits, including crossovers attending fewer than five group sessions (minimum threshold analysis).

Intervention Results: Women attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks' postpartum (18.0% vs. 15.2%, p < .001). At both treatment levels, group participants were less likely to elect permanent contraception (5.9% vs. 7.8%, p < 0.001). Women meeting the five-visit group threshold were not more likely to initiate contraception or LARCs within 8 weeks' postpartum.

Conclusion: Participation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance.

Study Design: Retrospective cohort

Setting: 18 healthcare practices serving Medicaid-enrolled women, South Carolina

Sample Size: 15922 Medicaid enrolled women (2834 women received CenteringPregnancy, 13088 received individual prenatal care)

Age Range: 14-44

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

Intervention Description: The South Carolina CenteringPregnancy Expansion Project provides training, technical assistance, and start-up funds to obstetric practices implementing the CenteringPregnancy™ model. Practices joined the initiative in several cohorts over seven years. The CenteringPregnancy model of group prenatal care includes all of the elements of the American College of Obstetrics and Gynecology’s recommended individual care physical assessment and screening visits. Prenatal care is provided in ten, two-hour group sessions with six to twelve women with similar due dates within a 4–6 week range. The first 30 min of each session is dedicated to individual, routine medical assessments by the healthcare provider, and the remaining 90 min are composed of group discussions and interactive activities facilitated by the medical care team using a curriculum focused on pregnancy, childbirth, and parenting-related topics. Women will also attend traditional, individual prenatal care visits early in pregnancy (i.e. before enrolling in the group), late in pregnancy (i.e. after the 10th session and before birth), as replacement for a missed group session, and if they require additional individualized follow-up.

Intervention Results: Women attending at least five group sessions had higher rates of postpartum visit attendance (71.5% vs. 67.5%, p < .05). Women with any group attendance (N = 2834) were more likely than women with individual care only (N = 13,088) to receive contraception within 3 days (19.8% vs. 16.9%, p < .001) and to receive a LARC within eight weeks’ postpartum (18.0% vs. 15.2%, p < .001).

Conclusion: Participation in at least five group compared to five individual prenatal care visits is associated with greater rates of postpartum visit attendance. Additional engagement and education in group prenatal care may influence postpartum visit attendance.

Study Design: Retrospective cohort analysis

Setting: 18 sites implementing the CenteringPregnancy model in South Carolina

Population of Focus: Pregnant women enrolled in Medicaid

Sample Size: 2,834 women with prenatal group attendance; 13,088 with individual care only

Age Range: 14--44

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Community-Based Group Education, Group Education, Telephone Support, Educational Material, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: The objective of this trial was to test if parents’ participation in an intervention based on an empowerment ideology and participatory experiences decreased the number of cigarettes smoked in homes.

Intervention Results: The median number of cigarettes smoked in the home daily decreased from 18 to 4 in the total sample (both groups about equally), however no statistically significant difference was detected between groups at 6 months follow-up.

Conclusion: Participation in the study, independent of group, may have resulted in parents decreasing the number of cigarettes smoked in the home. Valuable lessons were learned about recruiting and working with this group of parents, all of whom faced the challenges of tobacco and almost half of whom lived in poverty

Study Design: RCT

Setting: Community (home)

Population of Focus: Families connected with public health nursing offices, family resource centers, daycare centers, and kindergartens in Prince Edward Island, with at least one cigarette smoked daily in the home, children up to 5 years of age residing there, and one parent (smoker or not) willing to participate

Data Source: Data were collected in two intervieweradministered questionnaires competed in participants’ homes at baseline and 6-months follow-up.

Sample Size: 60 families

Age Range: Not specified

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

Intervention Description: To investigate, by using qualitative methods, beliefs among African-American and American Indian families about infant safe sleep practices, barriers to acceptance of prevention recommendations, and more effective messaging strategies.

Intervention Results: Themes included reasons for and influences on sleep decisions, and concerns about safe sleep recommendations. Parental sleep decisions seemed to be driven by perceptions of what would make their infant most comfortable and safe, and what would be most convenient. Parents were aware of safe sleep recommendations but unaware of the rationale. Because they generally did not believe that their infants were at risk for a sleep-related death, day-to-day decisions seemed to focus on what was most effective in getting their infant to sleep. There appeared to be no distinctions in opinions among African-American and American Indian families. African-American and American Indian families seemed to have similar concerns about infant comfort and safety, and their perceptions about what would be most effective in achieving these goals appeared to be important influences on their sleep practices.

Conclusion: Adherence with safe sleep recommendations may be enhanced if health care providers and educational materials discussed rationale underlying recommendations and addressed common parental concerns. It may be beneficial to target educational interventions towards fathers, as they may be untapped sources in implementing safe sleep practices.

Study Design: N/A

Setting: Focus Groups

Data Source: Mother and supporters participating in focus groups

Sample Size: 73 participants

Age Range: Mean age for the participants was 24.9 years for the mothers and 30.7 years for the supporters, and mean age for the children was 5.6 months for both groups.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, COMMUNITY, Other (Communities), POPULATION-BASED SYSTEMS

Intervention Description: To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.

Intervention Results: The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found.

Conclusion: A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.

Study Design: Pragmatic cluster RCT

Setting: 14 clusters of general practices

Population of Focus: Clusters of general practices that collected breastfeeding data through the Child Health Surveillance Program of the National Health Service Scotland from Oct 2002 forward

Data Source: Child Health Surveillance Programme

Sample Size: Intervention (n=7) Control (n=7) N=Clusters

Age Range: Not specified

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

Intervention Description: Assess the effectiveness of a culturally customized program (Esperanza y Vida [Hope and Life]) in increasing breast and cervical cancer screening among Latinas, and to examine how screening rates related to changes in cancer knowledge, differences in ethnic origins, and geographic location.

Intervention Results: Screening rates were significantly higher for the intervention versus the control group for clinical breast examination (CBE; 48% vs. 31%; adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.1-4.2), breast self-examination (45% vs. 27%; aOR, 2.3; 95% CI, 1.1-5.0), and Pap testing (51% vs. 30%; aOR, 3.9; 95% CI, 1.1-14.1), but not for mammography (67% vs. 58%; aOR, 0.7; 95% CI, 0.1-3.6).

Conclusion: Esperanza y Vida has the potential to reduce health disparities in breast and cervical cancer morbidity and mortality rates through increasing cancer screening and thereby increasing early detection.

Study Design: Cluster RCT

Setting: Arkansas and New York City, NY

Population of Focus: Latina women

Data Source: Telephone survey

Sample Size: Baseline (n=487) Intervention (n=308); Control (n=179) Follow-up (n=238)

Age Range: Mean: 39.3

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Other Person-to-Person Education, Motivational Interviewing, Group Education

Intervention Description: This study retrospectively evaluated the effect of smoking cessation intervention in pregnant women with smoking.

Intervention Results: After 12-week treatment, participants in the treatment group did not significantly reduce the number of participants quit smoking; decrease daily cigarettes consumption, and quit attempts in pregnant smokers, compared with subjects in the control group. At delivery, the comparison also did not show significant differences in the number of participants quit smoking, decreasing daily cigarettes consumption, and quitting attempts in pregnant smokers, as well as all infant outcomes between 2 groups.

Conclusion: The results of this retrospective study did not found that smoking cessation intervention may help to quit smoking for pregnant smokers.

Study Design: Cohort study- Retrospective observation

Setting: University hospital clinic

Population of Focus: Pregnant smokers aged from 18 to 40 years old, 12 to 24 weeks of gestation, with current cigarette consumption of more than 1 cigarette daily who could walk for 20 minutes daily

Data Source: Self-report, Urine cotinine

Sample Size: 176

Age Range: Not specified

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

Intervention Description: This study was an analysis of focus group data generated as part of a larger project focused on community involvement in Black maternal health. English speaking pregnant or recently postpartum women age 18 or older who receive services from BIH were recruited to participated in the focus group analyzed in this study. All facilitators of the focus group were Black women in order to facilitate candid conversation about racism in prenatal care.

Intervention Results: The need for mental health care was common thread underlying all conversations about prenatal health improve- ments desired by our focus groups. Participants expressed the centrality of mental health access during our discussion of other themes (e.g.: ease of access, inclusion of partners, special classes for teen moms) by discussing them in terms of their relationship to mental health. Our participants’ clear expression of the centrality of mental health care to their prenatal health guided our decision to focus on mental health as a necessary pillar of any group prenatal care intervention designed to mitigate perinatal healthcare disparities in this paper. Three themes related to mental health integration into group pre- natal care emerged from thematic analysis of the transcripts. Participants expressed insufficient access and advocacy, and provider distrust

Conclusion: Evidence exists supporting group prenatal care as a tool for mitigation of perinatal health disparities among Black women. There is also a large body of data describing the disproportionate burden of mental health needs among Black women. The rich data we present here from Black women on their desire for the integration of these two needs fits well into the parallel conversation occurring in the literature. To our knowledge, this is the first study investigating desires of Black women regarding group prenatal care designed specifically for them. They expressed a strong desire for more access to mental health care providers who are racially conscious and aware of white supremacy, and nuanced opinions on the role of racial concordance in health equity.

Study Design: Qualitative

Setting: Community-based

Population of Focus: Black birthing people

Sample Size: 11

Age Range: 18 years and older

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

Intervention Description: The Mindlink center providing screening, counseling, case management, therapy groups, family interventions, etc. for youth mental health.

Intervention Results: A community‐based early‐intervention service for youth was first introduced in 2012, when a special team was formed in a community mental health centre of Korea. As the numbers of young clients increased, a youth‐friendly, early‐intervention centre called Mindlink was opened in 2016. Mindlink targets those aged 15–30 years with mental illness less than 5 years in duration. Its goal is to detect mental illness in young people early and provide comprehensive multidisciplinary interventions. It provides intensive case management and group programmes including cognitive‐behavioural therapy, family intervention, psychoeducation, behavioural activation and physical health promotion. The Korean government has officially announced that the Mindlink model is effective and is currently in the process of scaling it up on a national level.

Conclusion: Our community‐based early intervention for youth mental health gradually evolved from a special team to the Mindlink centre and is ready for expansion to other areas. We are currently collecting more systematic evidence and hope to open hundreds of early‐intervention centres for Korean youth. Many young people with distressing mental illnesses, and their family members, now voluntarily visit Mindlink for help. They are seeking early psychiatric treatment despite the major associated stigma. Although stigma is problematic, low investment in effective mental health services may be of greater concern. Our experience with the Mindlink model suggests that investments in youth mental health and good service delivery can overcome stigma and other barriers to early access to mental health services.

Study Design: Quantitative analysis of an early intervention program

Setting: Community mental health center and separate Mindlink early intervention center in Gwangju, South Korea

Population of Focus: Community mental health center and separate Mindlink early intervention center in Gwangju, South Korea

Sample Size: 206 young people registered for services in 2019

Age Range: 15-30 years old

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

Intervention Description: Health visitors in the intervention group received an 18-hour training course. They then provided 1-3 home visits during the first 5 weeks postpartum focused on effective breastfeeding techniques, interpreting baby's cues, developing self-efficacy and confidence in breastfeeding.

Intervention Results: The study found that the postnatal breastfeeding support intervention had a significant positive effect on breastfeeding duration compared to usual practice. Mothers in the intervention group experienced a 14% lower rate of cessation of exclusive breastfeeding within the first 6 months after delivery relative to the control group. This beneficial effect was even larger, a 26% lower cessation rate, among multiparous women who had previously breastfed for a short duration. By 6 months postpartum, 7.7% of mothers in the intervention group were still exclusively breastfeeding compared to only 4.9% in the usual care control group. In the early postpartum period, the intervention also led to more frequent breastfeeding, less pacifier use, and greater maternal confidence in interpreting infant feeding cues among mothers receiving the postnatal home visit program focused on psychosocial and practical breastfeeding support.

Conclusion: Home visits in the first 5 weeks focusing on psychosocial and practical breastfeeding aspects may prolong exclusive breastfeeding duration. Postnatal support should focus on both these components, especially for mothers with little prior breastfeeding experience.

Study Design: Cluster-randomized trial

Setting: Western Denmark

Sample Size: 781 mothers in the intervention group and 816 mothers in the comparison group.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Nurse/Nurse Practitioner, Group Education,

Intervention Description: A continuing education program for perinatal nursing staff working in the labor and delivery unit, postpartum unit, and nursery was developed. The program was based on a review of literature and consisted of the incidence and prevalence of PPD and issues surrounding stigma associated with PPD. It also included a discussion of the symptoms, risk factors, diagnosis, and treatment of PPD, guidelines for screening, and resources for referral. The role of the nurse in the provision of PPD patient education related to patient teaching and anticipatory guidance was also included.

Intervention Results: For this study, a 10-question PPD knowledge-based pre- and posttest was administered. A paired-samples t test was calculated to compare the mean pretest score to the mean final exam score. The mean score on the pretest was 68.88 (SD = 10.25), and the mean score on the posttest was 94.14 (SD = 8.68). Nurses had a significant increase in PPD knowledge from pretest to posttest, t(24) = −9.690, p < .001.One hundred nine postpartum patients were discharged during the 4-week time prior to the intervention; 0.9% (P1) received postpartum depression (PPD) education prior to discharge. One hundred twenty-nine postpartum patients were discharged over the course of 4 weeks postintervention; 93.8% (P2) received PPD education.

Conclusion: Patient education is an essential component of nursing practice. This study found that perinatal nurses are more likely to provide PPD education to patients when they are more knowledgeable about the condition. It highlights the importance of a needs assessment and continuing education and professional development for nursing staff. Results support the use of continuing education to improve nurses’ confidence in their ability to provide patient education and to increase their knowledge of PPD. The outcomes of this study support research by providing strategies to increase nurses’ ability to educate patients on PPD.

Study Design: Quasi-experimental study

Setting: 150-bed regional hospital with 1,600 annual births

Sample Size: 26 nurses; 49% survey response

Age Range: 24-66

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): Educational Material, Community-Based Group Education, PATIENT/CONSUMER

Intervention Description: This study examined the feasibility and efficacy of Salud Es Vida – a promotora-led, Spanish-language educational group session on cervical cancer screening (Pap tests), self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds.

Intervention Results: While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores.

Conclusion: The group intervention approach was associated with increased cervical cancer knowledge, but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: 4 rural counties in Southeast GA

Population of Focus: Hispanic/Latino immigrant women ages 21-65 who had not had a Pap test in 2 years or more

Data Source: Written survey; cervical cancer screening questions were derived from the Health Information National Trends Survey

Sample Size: Baseline (n=176) Intervention (n=86); Control (n=90) Follow-up/Analysis (n=90) Intervention (n=38); Control (n=52)

Age Range: 21-65

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

Intervention Description: The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice.

Intervention Results: Group education is an instrument used by professionals in primary care that favors the acquisition of skills and modification of already-acquired behavior, all making it a potential method of choice to improve rates of exclusive breastfeeding in this period.

Conclusion: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO.

Study Design: community-based cluster randomised trial

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, Lactation Consultant, Educational Material, Group Education, Telephone Support

Intervention Description: The aim of this study was to evaluate the effectiveness of a multiphased midwifery intervention called the 'Milky Way' on any breastfeeding rates until six months.

Intervention Results: There were no significant differences in the antenatal baseline data between the groups. Compared to standard care, women in the Milky Way group had higher rates of breast feeding at one (83.7%, n=144 versus 61.3%, n=119, p<0.001), four (64.5%, n=111 versus 37.1%, n=72, p<0.001) and six months (54.3%, n=94 versus 31.4%, n=61 p<0.001).

Conclusion: Assignment to the Milky Way intervention was associated with significantly higher rates of breastfeeding compared with assignment to standard care only.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Tertiary hospital in South Western Sydney Area Health Services

Population of Focus: Nulliparous women ≥19 years old with basic English literacy

Data Source: Mother self-report

Sample Size: Enrolled • Intervention (n=172) • Control (n=194) 6-Month Follow-Up • Intervention (n=149) • Control (n=189)

Age Range: Not specified

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

Intervention Description: Between the pretest and posttest surveys, women in the intervention group participated in the educational program over three weekly educational sessions. The intervention group churches served as the education sites, with women participating in the educational sessions at the churches from which they were recruited. Each educational session lasted approximately two hours. Women participating in the educational sessions received a token payment of $5 for each session they attended. To implement the cervical cancer education program, we constituted 20 groups with 8 to 14 women per group. Women in the control group received the cervical cancer education booklets after the posttest surveys.

Intervention Results: Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3–3.2, p<.01) as likely to self-report Pap smear use at the posttest.

Conclusion: The findings support the efficacy of the multifaceted, theory-guided, culturally tailored community-based participatory cervical cancer education program for Samoan women in effecting positive changes in Pap smear use and cervical cancer-related knowledge and attitudes.

Study Design: Cluster RCT

Setting: Twenty-six Samoan-speaking churches on the main island of Tutulia in the American Samoa

Population of Focus: Samoan women a with no selfreported Pap smear in the past 2 years, no history of cervical cancer or hysterectomy, and plans to stay in the Territory throughout the study period

Data Source: Personal interviews

Sample Size: Total (N=416) Analysis (n=398) Intervention (n=201); Control (n=197)

Age Range: ≥20

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Enabling Services, Other Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: A 48-month community intervention was conducted to improve breast and cervical cancer (BCC) screening among Korean American (KA) women in Alameda County (AL), California. KA women in Santa Clara (SC) County, California served as a comparison group.

Intervention Results: After adjusting for all covariates, no significant difference in Pap smear rates between intervention and comparison counties.

Conclusion: Although our overall intervention did not appear to enhance screening practices at the community-level, attendance at a women's health workshop appears to have increased cervical cancer screening.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Alameda County and Santa Clara County, CA

Population of Focus: Korean American women

Data Source: Telephone survey

Sample Size: Total (N=2,176) Baseline (n=1,093); Follow-up (n=1,083) Analysis (participated in baseline or follow-up) (n=1,902) Baseline (n=818) Intervention (n=404); Control (n=414) Follow-up (n=1,084) Intervention (n=418); Control (n=458)

Age Range: ≥18

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, Educational Material, Community-Based Group Education, Patient Navigation, Enabling Services, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education, Designated Clinic/Extended Hours, Female Provider, COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Intervention Results: Significantly greater odds of Pap smear for women in intervention county than in control county (OR=2.02, 95% CI: 1.37-2.99)

Conclusion: A multifaceted community-based participatory research (CBPR) intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Santa Clara County, CA and Harris County, TX

Population of Focus: Vietnamese women living in either county

Data Source: Computer-assisted telephone interviewing system

Sample Size: Baseline(n=1,566) Intervention (n=798); Control (n=768) Follow-up (n=2,009) Intervention (n=1,004); Control (n=1,005)

Age Range: ≥18

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

Intervention Description: The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community.

Intervention Results: Follow-up data revealed significant improvements in all outcome measures.

Conclusion: The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them.

Study Design: RCT: pretest-posttest

Setting: South Philadelphia, PA

Population of Focus: Hispanic women

Data Source: In-person interview administered in Spanish by the promotoras

Sample Size: Total (N=120) Intervention (n=60); Wait-List Control (n=60) Analysis (n=70) Intervention (n=34); Wait-List Control (n=36)

Age Range: 18-65

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): Group Education, Sleep Environment Modification, Training (Parent/Family)

Intervention Description: Eighty-three mothers participated in focus groups or individual interviews. Questions probed reasons for infant sleep position decisions and influences on decision making.

Intervention Results: All of the mothers in this study were aware of the recommendation to place infants supine for sleep. Mothers largely chose infant sleep position for either safety or comfort reasons. Many mothers who chose the prone position did so because they perceived it to be safer than supine. Sleep position decisions were influenced by parental needs (largely the need for sleep), perception of SIDS risk and biological plausibility, and trusted sources of information. Mothers sought information from multiple trusted sources before making any decision. Even if mothers had trust in their pediatrician, they were comfortable making decisions counter to their pediatrician's recommendations if they felt it to be in the best interests of their infant.

Conclusion: African American mothers are generally aware of the Back to Sleep recommendation. However, many may not believe that the supine position is the safest position. Other mothers may use the prone position because of infant comfort or parent's need for longer sleep. Trust in the pediatrician may not be sufficient reason for parents to use the supine position.

Study Design: N/A

Setting: Washington, DC, and Maryland

Data Source: Mother interview

Sample Size: 83 mothers

Age Range: parents with infants 0 to 6 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Educational Material, Peer Counselor, Motivational Interviewing, Pharmacotherapy (Nicotine), Other Person-to-Person Education, Group Education, Community-Based Group Education

Intervention Description: To assess the feasibility and acceptability of implementing a culturally tailored, intensive smoking cessation program, including contingency-based financial rewards (CBFR), for pregnant Aboriginal women.

Intervention Results: Twenty-two of 38 eligible women (58%) enrolled in the program, with 19 (86% remaining at the end of their pregnancy. The program was highly acceptable to both women and providers. Feasibility issues included challenges providing twice-weekly visits for 3 weeks and running fortnightly support groups. Of the 19 women who completed the program, 15 (79%) reported a quit attempt lasting >=24 hours, and 8 (42%) were CO-confirmed as not smoking in late pregnancy. The rewards were perceived to help motivate women, but the key to successful quitting was considered to be the intensive support provided.

Conclusion: 'Stop Smoking in its Tracks' was acceptable and is likely to be feasible to implement with some modifications. The program should be tested in a larger study.

Study Design: Single group pre-post test

Setting: Aboriginal Maternal and Infant Health Services clinics

Population of Focus: Pregnant aboriginal women seeking prenatal care at health services sites who were smoking and older than 16 years and less than 20 weeks gestation who were local residents

Data Source: Self-reported smoking levels, breath CO

Sample Size: 38, 19 completed the program

Age Range: Not specified

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

Intervention Description: examine the impact of parental involvement, peer relationships, and adult mentors on the character development of adolescents during their high school years

Intervention Results: The study found that parental involvement significantly predicted youth’s self-assessed character at each of the freshman, sophomore, junior, and senior years. Peer relationships were predictive at the freshman, sophomore, and senior years, while adult mentors were predictive at only the freshman year. The hierarchical multiple regression analysis revealed parental involvement to be significant across all four years in the study. Peer relationships were significant during three of the four years, specifically freshman, junior, and senior years. However, adult mentors were negatively significant for the sophomore and junior years, and not significant for the senior year . These results suggest that parental involvement has a more enduring impact on character development compared to peer relationships and adult mentors .

Conclusion: The study concluded that parental involvement significantly predicts youth’s self-assessed character across all four years of high school, while peer relationships are predictive at the freshman, sophomore, and senior years. In contrast, adult mentors were only predictive at the freshman year and were negatively significant for the sophomore and junior years. The results suggest that parental involvement in predicting character is more enduring than peer relationships, which is consistent with previous research. However, the study also highlighted the need for additional research to understand the specific role of adult mentors in character development, as well as other developmental areas of high school adolescents .

Study Design: longitudinal design, drawing data from Waves 5 through 8 of the 4-H Study of Positive Youth Development

Setting: Community-based: 4-H Study of Positive Youth Development in US - 40 cities/towns in 13 states

Population of Focus: high school students

Sample Size: small sample size

Age Range: mean age of 15.11 years

Intervention Components (click on component to see a list of all articles that use that intervention): Peer-led Mentoring/Support Counseling, Group Education, Social Network/Peer,

Intervention Description: Participants were randomly assigned to either six sessions Mein Weg (n = 50; Mage = 17.00, 94% male) or UC (n = 49; Mage = 16.92, 92% male).

Intervention Results: Intention-to-treat analyses showed that Mein Weg was significantly superior to UC regarding symptom improvement of self-reported PTSS (Mein Weg: d = .61, UC: d = .15) and depression (Mein Weg: d = .63, UC: d = −.06), but not regarding caregiver-reported symptoms and self-reported dysfunctional posttraumatic cognitions.

Conclusion: In summary, this trial provides evidence of the feasibility and effectiveness of the trauma-focused group intervention Mein Weg as a community-based lowlevel cognitive-behavioral intervention for traumatized UYRs. Furthermore, the inconsistency between self-reports and caregiver reports on stress symptoms indicates the need to train social workers to be more sensitive to trauma-related issues and symptoms, as this is usually not included in their education. The benefits from implementing this intervention are twofold. The UYRs report on average improvements in their PTSS and depression and the social workers receive specific trauma-focused training and are thus empowered in their daily work with the refugee population. The intervention could be a valuable lowthreshold component in a stepped care approach.

Study Design: Randomized controlled trial

Setting: Child and adolescent welfare agencies in Germany

Population of Focus: Young refugees with posttraumatic stress symptoms

Sample Size: 50 in the intervention group, 49 in the control group

Age Range: Mean age 17 years old (range not provided)

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

Intervention Description: The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam. To counteract this trend, a language and culture specific education program was developed.

Intervention Results: Results suggested that the education program had significant effects on knowledge, attitudes, planned and actual behaviour towards breastfeeding. However, the effect did not sustain until 6 months postpartum.

Conclusion: Implications for nursing practice and further research are discussed.

Study Design: QE: non-equivalent control group

Setting: Western and South Western Sydney, New South Wales

Population of Focus: Vietnamese women who were at least 12 weeks pregnant

Data Source: Mother self-report

Sample Size: Intervention (n=108) Control (n=86)

Age Range: Not specified

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

Intervention Description: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women.

Intervention Results: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times.

Conclusion: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Study Design: QE: non-equivalent control group

Setting: 2 WIC clinics in Flagstaff, AZ

Population of Focus: Primiparous women with an expected due date between May and Dec 1992

Data Source: Mother self-report

Sample Size: Intervention (n=26) Control (n=26)

Age Range: Not specified

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, Peer Counselor, Motivational Interviewing, Educational Material, Other Person-to-Person Education, Community-Based Group Education, Group Education, Incentives

Intervention Description: Given serious consequences of maternal smoking, we aimed to develop and test a multicomponent behavioral intervention to enhance smoking cessation during pregnancy.

Intervention Results: The estimated smoking cessation rate was 70.0% (21/30) at the second week of the intervention, and 63.3% (19/30) at the conclusion of the 8-week intervention assuming the dropouts as smoking. In interrupted time series analysis, the mean daily number of cigarettes smoked among quitters decreased by 6.52, 5.34, and 4.67 among early, delayed, and late intervention groups, respectively. Quitters' mean urine cotinine level maintained stably high before the intervention but decreased rapidly to the nonsmoking range once the intervention was initiated. Most participants (85.7%) reported meeting or exceeding expectations, and 100% would recommend the program to others.

Conclusion: This pilot multicomponent intervention was feasible and acceptable to most participants, resulting in a high smoking cessation rate among pregnant smokers who were unlikely to quit spontaneously.

Study Design: Cohort-Multiple-baseline intervention pilot studymultiple interrupted time series approach

Setting: Community-based prenatal clinics

Population of Focus: English speaking pregnant women who are current smokers without alcohol or drug dependency or mental health disorders

Data Source: Urine cotinine, self-report calendar of cigarette use

Sample Size: 30

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Community-Based Group Education, Telephone Support

Intervention Description: To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on maternal and child health outcomes.

Intervention Results: At 12 and 18 months, there was little impact for either intervention on the main outcomes: child injury (SHV: relative risk 0.99; 95% confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use (with fewer taking their children to the GP) and had less anxious experiences of motherhood than control women. User satisfaction with the SHV intervention was high. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention.

Conclusion: There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population. The SHV intervention was associated with improvement in some of the secondary outcomes.

Study Design: RCT with two intervention groups

Setting: Community (Well-child visit)

Population of Focus: Women from culturally diverse background with infants in two disadvantaged boroughs of London, UK

Data Source: Questionnaires at baseline, 12 and 18 month follow-ups.

Sample Size: 731 mothers with 183 allocated to support health visitor intervention, 184 to community group services intervention, and 364 to control group

Age Range: Not specified

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

Intervention Description: A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California.

Intervention Results: No significant differences in Pap smear rates between the intervention and comparison counties

Conclusion: After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Alameda County and Santa Clara County, CA

Population of Focus: Korean American women

Data Source: Telephone survey

Sample Size: Baseline (n=818) Intervention (n=404); Control (n=414)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Provider Training/Education, Health Insurance Coverage, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Fifty percent of adolescents experienced PCMH care, with little change between 2004 and 2013. Adolescents with MH need (N = 3,794) had significantly lower odds of experiencing PCMH care compared with those without MH need (odds ratio, .78; 95% confidence interval, .69-.87). Among adolescents with MH needs, being uninsured and living with a parent who did not graduate high school were negatively associated with PCMH care, whereas parental usual source of care was positively associated (odds ratio, 1.69; 95% confidence interval, 1.28-2.22).

Conclusion: Increasing care accessibility, integrating MH services into primary care settings, and targeting socioeconomically disadvantaged subgroups could improve rates of PCMH care among adolescents with MH needs.

Study Design: This was a secondary analysis of Medical Expenditure Panel Survey data (2004-2013). The sample included adolescents aged 12-17 years with ≥1 office-based visits in the past year (N = 18,717). Questions assessing a usual source of care and care that is accessible, comprehensive, family-centered, and compassionate were used to define PCMH care. For adolescents with MH needs, multivariable logistic regression was used to describe the association between PCMH care and sample characteristics.

Setting: Medical Expenditure Panel Survey

Population of Focus: Adolescents

Sample Size: 3794

Age Range: 12/17/2024

Intervention Components (click on component to see a list of all articles that use that intervention): , EMR Reminder, Targeting Interventions to Focused Groups, Educational Material, Mobile Apps, Online Material/Education/Blogging

Intervention Description: The study primarily focuses on developing a data-driven primary intervention approach using machine learning and electronic health records (EHR) data to identify pregnant women at risk for postpartum depression (PPD) . The intervention aligns with a discernible strategy of leveraging machine learning algorithms to predict PPD risk based on EHR data, with the potential for early prevention, diagnosis, and intervention . The study does not analyze a multicomponent intervention; rather, it focuses on the development and validation of a machine learning algorithm for PPD risk prediction using EHR data. The intervention strategy is centered around leveraging data-driven approaches to identify at-risk individuals and potentially tailor therapeutic interventions, screening timelines, and preventive strategies for PPD

Intervention Results: The study analyzed a total of 15,197 deliveries from January 2015 to June 2018, and the prevalence of depression was 6.7% (N=1,010) and 6.5% (N=3,513) in the WCM and NYC-CDRN datasets, respectively . The machine learning algorithm was able to predict PPD risk with an area under the receiver operating characteristic curve (AUC-ROC) of 0.83 (95% CI: 0.81-0.85) in the training dataset and 0.80 (95% CI: 0.77-0.83) in the validation dataset . The study found significant differences in age, the number of emergency department visits, and racial distribution between PPD and non-PPD groups in the training and validation data . The study demonstrates that a data-driven primary intervention approach using machine learning and EHR data may be leveraged to reduce the healthcare provider burden of identifying PPD risk.

Conclusion: Machine learning-based models incorporating EHR-derived predictors, could augment symptom-based screening practice by identifying the high-risk population at greatest need for preventive intervention, before development of PPD.

Study Design: The study design was a prospective cohort study that used electronic health records (EHR) data to develop and validate a machine learning algorithm for predicting the risk of postpartum depression (PPD) among pregnant women . The study used two EHR datasets containing data on 15,197 women from 2015 to 2018 at a single site and 53,972 women from 2004 to 2017 at multiple sites as development and validation sets, respectively . The study included all pregnant women with fully completed antenatal care procedures who had live births of infants, and the exclusion criteria were maternal age below 18 or above 45, or lack of outpatient, inpatient, or emergency room encounter information in the EHR data within 1 year following childbirth . The study was approved by the Institutional Review Board at Weill Cornell Medicine (IRB protocol# 1711018789), and data extraction and analysis were performed in 2019 . The study used a well-defined outcome measure of PPD diagnosis within 1 year following childbirth, and the machine learning algorithm was able to predict PPD risk with a high degree of accuracy

Setting: The study setting for the development dataset was a single site, and the validation dataset included data from multiple health systems across New York City affiliated with the Patient-Centered Outcomes Research Institute funded New York City Clinical Data Research Network data (NYC-CDRN) . Therefore, the study setting primarily involved healthcare institutions and systems in New York City, USA.

Population of Focus: The target audience for the study includes healthcare professionals, researchers, and policymakers involved in maternal and mental health, as well as professionals working with electronic health records (EHR) and machine learning applications in healthcare. Additionally, the findings of the study may be of interest to organizations and institutions involved in developing and implementing predictive models for identifying and addressing the risk of postpartum depression among pregnant women.

Sample Size: The study included a total of 15,197 deliveries from January 2015 to June 2018 in the development dataset, and 53,972 deliveries from August 2004 to October 2017 in the validation dataset . These datasets were used to develop and validate a machine learning algorithm for predicting the risk of postpartum depression among pregnant women.

Age Range: The study included pregnant women within a specific age range. The exclusion criteria for the study were maternal age below 18 or above 45 . Therefore, the age range of the included pregnant women in the study was 18 to 45 years old.