Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs

Abstract

Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

Figure 1

STAR MAMA HIT automated telephone messages content and mode of delivery: Maternal and Child Information (Edu), Queries (Q), Narrative, or Tip/Text.

Figure 2

STAR MAMA health-IT intervention linkage model: using the health coach as a bridge between the community and hospital infrastructure for postpartum GDM women. (1) A woman is enrolled into the STAR MAMA study based on her eligibility. See Table 1 for baseline demographics. Eligible WIC participants were referred to the STAR MAMA study by their respective coordinators. (2) Enrolled participants select call times to receive proactive calls or call in toll-free from the automated telemedicine system. Each week participants receive a rotating set of prevention-focused queries, narratives, and texts (e.g., on diet, exercise, breastfeeding, and baby care). If a participant enters a value predefined as “out of range,” participants also hear recorded first person supportive narratives related to their “out-of-range” reply encouraging behavior change as well as narratives offering shorter tips. (3) Each participant is matched with a health coach, a trained nonprofessional individual recruited for this study. The health coach is trained on health coaching protocol and diabetes prevention (Center for Excellence in Primary Care). The coach receives automatically downloaded daily reports from the ATSM calls and participant responses. Depending on the participant's needs, the health coach calls back to provide participant with emotional support and engage participant in goal setting/action and provides information about community resources. (4) ((4a) and (4b)) The health coach can connect the patient with community programs, food banks, farmers markets, WIC counselors, mental health support groups, and so forth. Additionally, the coach may send a notification to a patient's clinic and/or clinician if deemed urgent, based on predetermined protocols.

Figure 3

HIT enabled phone call system, participant triggers, and context-based health coaching messages: summary for Ms. C. at San Francisco WIC. Timeline of calls and weekly triggers indicated by Ms. C. The timeline displays the weekly phone calls to Ms. C., from weeks 1 through 20 by the ATSM system. The diamonds indicate triggers and actionable events, and the table summarizes the reason for triggers each week. A health coach monitors the daily and weekly reports from the HIT system to follow-up with the participants through a trigger based approach.

Figure 4

Multimodal adaptation of the STAR MAMA HIT/health coaching hybrid model to meet community needs. This model breaks down the different modes of implementation of the STAR MAMA model to illustrate the flexibility of supporting self-managed care within the clinic to community spectrum. Both components of the model, HIT and health coaching, have the capacity to interact uni- or bidirectionally with the patient in the clinic or community setting. (1) STAR MAMA: the STAR MAMA intervention is a blend of weekly HIT phone calls to eligible patients and health coaching calls for support and follow-up. (2) ATSM: this is one component of the STAR MAMA model, in which patients receive weekly phone calls for 20 weeks on various topics regarding postpartum health. The calls can be implemented in the community setting unidirectionally, in which the patient listens to educational narratives, or the phone calls can be programmed to offer an interactive component. (3) Health coaching: trained health coaches can provide topic-based counseling to patients regarding specific topics tailored to the patient's needs. Or the health coach can receive triggers from an HIT system (if both are used in conjunction) to follow-up with patient on high risk issues.