College of Public Health, Kent State University, 750 Hilltop Drive, 339 Lowry Hall, P.O. Box 5190, 44242, Kent, OH, United States.
Matern Child Health J. 2023 Mar;27(3):459-467. doi: 10.1007/s10995-022-03522-2. Epub 2022 Nov 9.
The THRIVE (Toward Health Resiliency and Infant Vitality & Equity) program aims to reduce racial disparities in birth outcomes by addressing individual risks and social determinants of health using the Pathways Community HUB model. This study examines (1) racial disparities among THRIVE participants and propensity score matched (PSM) comparisons in adequacy of prenatal care, and whether THRIVE participation (2) attenuates such disparities, and (3) improves odds of having adequate prenatal care.
Birth certificate and Care Coordination Systems client data were merged for analysis. PSM was employed for 1:1 matching per birth year (2017-2020) and race for participating and non-participating first-time births in Stark County, Ohio. Additional matching variables were age, marital status, education attainment, birth quarter, census tract poverty rate, and Women Infant & Children (WIC) enrollment. Logistic regression assessed racial differences in adequate prenatal care utilization (APNCU) and examined differences between the intervention and comparison groups on APNCU.
THRIVE participants averaged more prenatal care visits and had a higher percentage of adequate care utilization than the comparison group. THRIVE program participation, educational attainment, and WIC enrollment were associated with higher odds of adequate prenatal care utilization (OR 4.74; 95% CI 2.62, 8.57). Race was not significant for APNCU.
Although accessing and maintaining prenatal care is only one aspect of improving birth outcomes, the findings contribute to the understanding of the effects of the program of interest and other similar programs on factors which may promote desired birth outcomes in high-risk populations.
THRIVE（促进健康复原力和婴儿活力与公平）计划旨在通过使用 Pathways 社区中心模型解决个人健康风险和社会决定因素，减少出生结果中的种族差异。本研究考察了：（1）THRIVE 参与者中的种族差异和倾向评分匹配（PSM）比较在产前保健充足性方面的差异，以及（2）THRIVE 参与是否减轻了这些差异，以及（3）是否提高了获得充足产前保健的几率。
将出生证明和护理协调系统客户数据合并进行分析。采用 PSM 按出生年份（2017-2020 年）和种族对俄亥俄州斯塔克县首次参与和非参与的分娩进行 1:1 匹配。其他匹配变量包括年龄、婚姻状况、教育程度、分娩季度、普查区贫困率和妇女、婴儿和儿童（WIC）的参与情况。逻辑回归评估了种族间充分利用产前保健的差异，并比较了干预组和对照组在充分利用产前保健方面的差异。
THRIVE 参与者的平均产前保健就诊次数更多，充分利用产前保健的比例也更高。THRIVE 项目参与、教育程度和 WIC 参与与更高的充分利用产前保健几率相关（OR 4.74；95%CI 2.62,8.57）。种族对 APNCU 没有显著影响。
尽管获得和维持产前保健只是改善出生结果的一个方面，但这些发现有助于了解计划的影响和其他类似计划对可能促进高危人群期望的出生结果的因素的影响。
