30000 Participants Needed

Data Accountability + Doula Support for Maternal Health Disparities

(ACURE4Moms Trial)

JH
LC
RS
Overseen ByRabab S Hussain, MIS
Age: Any Age
Sex: Female
Trial Phase: Academic
Sponsor: University of North Carolina, Chapel Hill
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to reduce disparities in pregnancy care and outcomes between Black and White expectant mothers. It tests various approaches, including standard care, data-driven improvements (Data Accountability and Transparency), and additional support from community doulas (trained companions who assist during and after childbirth, known as Community-Based Doula Support). Set in prenatal practices across North Carolina, the trial seeks to determine which combination of these methods is most effective. Black or African American pregnant patients on Medicaid who begin prenatal care at one of the participating clinics may find this trial suitable. As an unphased trial, it offers a unique opportunity to contribute to research that could enhance pregnancy care for future generations.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that support from community-based doulas can positively impact the health of mothers and their babies. Doulas, trained to assist during pregnancy and childbirth, are linked to better experiences and outcomes for both mothers and infants. Studies have not identified any safety concerns or negative effects from using community-based doulas.

The Data Accountability and Transparency intervention differs slightly. It uses data to track and improve maternal health outcomes. Although this approach is newer and lacks specific safety data, it focuses on enhancing healthcare practices rather than involving physical procedures, suggesting a low risk of negative effects.

Both approaches aim to improve maternal health and reduce health disparities without introducing new medications or invasive procedures. Based on current research and their nature, they are generally considered safe.12345

Why are researchers excited about this trial?

Researchers are excited about the Data Accountability and Doula Support trial because it tackles maternal health disparities using a fresh approach. Unlike standard care, which typically involves basic risk screening and management, this trial combines two innovative strategies: Community-Based Doula (CBD) support and enhanced data accountability methods. The CBD support provides pregnant patients with personalized care and education, fostering a trusted relationship and potentially improving outcomes. Meanwhile, the data accountability approach uses advanced tools like a Maternal Warning System and Data Dashboard to monitor and address health indicators proactively, ensuring more equitable care across diverse populations. This trial aims to find out if these combined strategies can effectively reduce the risks associated with low birthweight and improve maternal health equity.

What evidence suggests that this trial's treatments could be effective in reducing maternal health disparities?

Research has shown that having a community-based doula, one of the interventions in this trial, can improve birth outcomes, such as fewer C-sections and healthier birth weights. Doulas offer emotional, physical, and informational support to mothers before, during, and after childbirth. These benefits have been observed across various groups, particularly in communities with limited access to healthcare.

Another intervention in this trial is data accountability and transparency. Research indicates that using data to hold healthcare providers accountable can reduce disparities in maternal care. This approach aims to improve practices for better outcomes, such as reducing low birth weight in Black infants. Tools like data dashboards highlight these differences and encourage better healthcare practices.23467

Who Is on the Research Team?

JH

Jennifer H Tang, MD, MSCR

Principal Investigator

University of North Carolina, Chapel Hill

RP

Rachel P Urrutia, MD, MSCR

Principal Investigator

University of North Carolina, Chapel Hill

Are You a Good Fit for This Trial?

This trial is for Black or African American individuals starting prenatal care at one of the 40 North Carolina clinics involved. Participants must be able to consent and communicate in English. Clinics should have a history of at least 180 Black deliveries over two years, agree to randomization, and follow study protocols.

Inclusion Criteria

Patient participants must be able to give consent and complete surveys and interviews in English
Doula participants must provide doula care to patients at one of the 40 clinic groups in this study
Practices must be willing to adhere to the study protocol
See 4 more

Exclusion Criteria

Practices already integrated with Community-Based Doulas
Practices already have an Early Warning System or Disparities Dashboard

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive interventions based on their assigned arm, including Data Accountability, Community-Based Doula Support, or both.

2 years
Regular visits as per intervention protocol

Follow-up

Participants are monitored for outcomes such as low birthweight and experiences of discrimination up to 1 year post-delivery.

1 year

What Are the Treatments Tested in This Trial?

Interventions

  • Community-Based Doula (CBD) Support
  • Data Accountability and Transparency
Trial Overview ACURE4Moms tests interventions against racial disparities in maternal health: standard Medicaid management, plus either data accountability measures, community-based doula support during/after pregnancy, or both. The outcomes from these four approaches will be compared.
How Is the Trial Designed?
4Treatment groups
Active Control
Group I: Community-Based Doula (CBD) SupportActive Control1 Intervention
Group II: Data Accountability and Transparency + Community-Based Doula SupportActive Control2 Interventions
Group III: Data Accountability and TransparencyActive Control1 Intervention
Group IV: Standard CareActive Control1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of North Carolina, Chapel Hill

Lead Sponsor

Trials
1,588
Recruited
4,364,000+

Patient-Centered Outcomes Research Institute

Collaborator

Trials
592
Recruited
27,110,000+

The Duke Endowment

Collaborator

Trials
17
Recruited
48,100+

UNC Health Foundation

Collaborator

Trials
1
Recruited
30,000+

Published Research Related to This Trial

Continuous labor support from trained doulas significantly improves maternal and infant health outcomes, enhances satisfaction with maternity care, and can reduce healthcare costs.
To increase access to doula services, especially for at-risk women, eliminating cost barriers through Medicaid and private insurance coverage is essential, with various pathways identified for reimbursement.
Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health.Strauss, N., Sakala, C., Corry, MP.[2020]
Foreign-born women in Sweden reported that community-based doulas (CBDs) not only supported them during labor but also provided crucial information and continuity of care, enhancing their satisfaction and trust in maternity health services.
The training of CBDs can improve equitable maternity care, highlighting its importance in diverse populations, not just in Sweden but in other countries with similar demographic changes.
Foreign-born women's experiences of Community-Based Doulas in Sweden--a qualitative study.Akhavan, S., Edge, D.[2012]
A randomized trial involving 367 participants at an urban safety net hospital found that community doula support did not significantly change overall birth outcomes compared to standard care, but showed promising trends for Black non-Hispanic participants, including a 12% reduction in cesarean births and an 11.5% increase in exclusive breastfeeding rates.
The study highlights the potential benefits of community doula support in improving health equity for Black birthing people, suggesting that further research is needed to explore these effects more comprehensively.
Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial.Mottl-Santiago, J., Dukhovny, D., Cabral, H., et al.[2023]

Citations

The Effect of Doulas on Maternal and Birth OutcomesThe studies in this review indicated that doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections.
Community-based doulasOur evidence rating is not based on these outcomes, but these benefits may also be possible: Reduced low birthweight births. Reduced preterm ...
Doula Care and Maternal Health: An Evidence ReviewKEY POINTS. • Doulas provide emotional, physical, and informational support before, during, and after labor and birth.
United States Doula Programs and Their OutcomesStudies have found that doula care is associated with lower rates of low birthweight newborns across settings and populations, in community-based settings and ...
Community-Based Models Improve Maternal Outcomes ...Community-based models of care, including group prenatal care and pregnancy medical homes, may improve maternal health outcomes.
amutah-onukagha, ndidiamaka - NIH RePORTERAbstract (Project Summary) Black women experience stark disparities in pregnancy care, complications, and outcomes, compared to White women.
Doula care across the maternity care continuum and impact ...The use of doulas appears an effective strategy for improving maternal health, especially among socioeconomically vulnerable and marginalized minority ...
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