Purpose

Depression and anxiety during and after pregnancy are common medical complications contributing to a rising maternal mortality rate. Home visiting programs (HVPs) can improve mental health outcomes for vulnerable pregnant populations. If our long-term goal is to reduce disparities in adverse maternal outcomes and improve community health, it’s critical to work with multilevel stakeholders including HVPs, community representatives, underrepresented and minority birthing people in rural geographies, and state departments of public health.

The explicit requests of our Iowa Department of Health and Human Services and Indiana Departments of Health partners have guided our work, specifically in the current context of reproductive policy. Our ethnographically-driven research explores the relationship between an intervention, implementation, and context, both programmatic (e.g., funding, training, model) and structural (e.g., rurality, environmental exposures). Our work will explore the impact of context on the implementation of a mental health intervention to provide action-based and impactful data that focuses on the lived experiences of the diverse populations served by HVPs in Iowa and Indiana. 

What is the goal of IMPACT ?

The IMPACT study will engage multilevel community and professional partners (e.g., policymakers, frontline implementers, and intervention recipients) to adapt implementation facilitation to integrate a maternal mental health intervention (i.e., Mothers and Babies) across two midwestern, rural states (Iowa and Indiana) with multiple HVP models. Given the complexity and heterogeneity of the contexts in which Mothers and Babies will be integrated, a three-variable hybrid implementation-effectiveness-context trial will test the adapted facilitation strategy compared with implementation as usual (i.e., standard education) and will assess contextual factors related to the outcomes. Using an evidence- based implementation strategy that tailors implementation delivery to the needs of the specific populations and context may improve fidelity and adoption, particularly in rural states where residents have limited access to care.

How does IMPACT support implementation?

Implementation Science is a rapidly-growing field intended to put research findings into practice. Implementation science was established to study the most effective strategies to integrate evidence-based interventions into public and community health and health care delivery. Implementation science asks whether an intervention can be effectively delivered in a specific local context, that is, under what conditions and in what contexts can any change-oriented action be effective in the real world?