"Maternal Outcome Monitoring and Support (MOMS) - A mHealth symptom self-monitoring and decision support system to reduce racial and ethnic disparities in postpartum outcomes

PROJECT ABSTRACT/SUMMARY Severe maternal morbidity (SMM) rates have risen 120-200% in the United States in the past two decades,1 and experts estimate that 40-60% of these cases are preventable.2,3 Suicide or self-harm related to postpartum psychiatric issues, although typically reported separately from SMM, is the second leading cause of maternal death.4,5 There additional intensive-acute psychiatric events (IAPE) that do not result in death not reflected in statistics of SMM. Improvement initiatives are predominantly hospital-based and rely on women recognizing their own symptoms and seeking care without ample support or education. We hypothesize that we can improve patients’ self-efficacy and decision-making about when to seek care by helping them to self-monitor symptoms and by providing decision support. We propose to develop a mHealth-based, patient-reported outcome (PRO) and decision-support system to help mothers determine when to seek care for warning signs of SMM. Our project focuses on diverse populations facing postpartum disparities, particularly African- American and Spanish-speaking Latina women. The long-term goal is to enable Dr. Benda to leverage this work into an independent research program, which will design, evaluate, and implement technologies to improve health equity. Using the robust resources of Weill Cornell Medical College and external advisors, work in the K99 phase will develop and validate a framework of design requirements for postpartum symptom reporting and decision-support needs. In the R00 phase, Dr. Benda will independently design, evaluate, and pilot a mHealth PRO and decision-support tool to improve knowledge and self-efficacy for postpartum patients in the areas of SMM and IAPE. The specific aims are to: 1) develop and refine a framework of design requirements for postpartum symptom reporting and decision-support needs; 2) design and evaluate a functioning prototype of MOMS/MAMA through heuristic feedback with experts usability testing with patients; and 3) conduct a pilot trial assessing the feasibility and preliminary effectiveness of MOMS/MAMA for improving knowledge and self-efficacy among postpartum patients at risk of SMM. To accomplish these aims, we have assembled an interdisciplinary team with research expertise in informatics, nursing, public health, minority health, clinical trials, and technology design and evaluation. Our team also has clinical domain expertise in obstetrics/gynecology and psychology/psychiatry. Our proposal addresses important public health issues (SMM and IAPE) and seeks to reduce disparities by targeting minority groups most affected by them. Given the array of new competencies and the multidisciplinary nature of the patient-centered work, this K99/R00 award is a necessary step to achieve the candidate’s career goal of designing technology-based interventions to advance health equity.