- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05993689
Building TrUst and UNiting Teams Through DouLa partnErship - BUNDLE (BUNDLE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The BUNDLE study is a prospective mixed-methods study focused on the early integration of community doula into prenatal care. The investigators will pursue the following aims using a multidisciplinary team of experts in health disparities, community engagement, qualitative research, maternal-fetal medicine, and doula support:
Aim 1: Develop an integrated prenatal care model of medical providers and community doulas in Southeastern Wisconsin Approach: The investigators will conduct six focus groups with 30 Black/AA birthing people (currently pregnant or recently postpartum) and 30 prenatal healthcare providers (obstetricians, midwives, doulas, social workers, prenatal care coordinators, nurses, mental health providers, and obstetric unit leaders) to elicit feedback on models of doula/medical provider integration with the overarching aim of building trust and improving maternal health outcomes. Focus group findings will be reviewed with a community advisory panel (CAP) developed as part of the Community Partnership of the MCW U54 center, to gain the CAP's input on intervention development.
Aim 2: Compare the effectiveness of the integrated prenatal care model to standard prenatal care in improving healthcare engagement and trust and reducing adverse maternal outcomes Approach: In a two-arm randomized controlled trial conducted at Froedtert and MCW, the investigators will randomize 412 Black/AA pregnant people to BUNDLE or standard prenatal care. Primary outcome is healthcare engagement (starting prenatal care in 1st trimester, attending at least 70% of the recommended visits, attending the postpartum visit, and receipt of recommended vaccination during pregnancy). Secondary outcomes include medical mistrust measured by trust in provider scale, perceived discrimination, and frequencies of severe maternal morbidity as defined by the Centers for Disease Control.
Aim 3: Disseminate findings to scholarly and community-based forums and actively pursue opportunities for systems- and policy-level change Approach: The investigators will disseminate findings regularly in scholarly (conference, grand rounds) and community-based (listening session, town hall) forums. The investigators will leverage the existing partnerships with policymakers, healthcare organizations, and community leaders to implement strategies to sustain successful program outcomes through policy changes at the system and statewide level by advocating for doula coverage and healthcare system sustainability of the integrated prenatal care model.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Anna Palatnik, MD
- Phone Number: (414) 805-6624
- Email: apalatnik@mcw.edu
Study Contact Backup
- Name: Joni S Williams, MD, MPH
- Phone Number: (414) 955-8827
- Email: jswilliams@mcw.edu
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Self-reported Black or African American
- Pregnant with singleton gestation
- Has an established OBGY at Froedtert & the Medical College of Wisconsin (F&MCW) Health System
Exclusion Criteria:
- Planning to deliver outside of F&MCW Health System
- Receiving support beyond routing prenatal care, such as group prenatal care or has their own doula
- Inability or unwillingness to provide informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: BUNDLE Intervention
Proposed components of the intervention will include: 1) attendance at two visits in the 2nd trimester and two visits in the 3rd trimester by a doula; 2) exchange of contact information between the clinic and the doula; 3) exchange of social needs and social-structural risk factors complicating patient's prenatal care from doula and exchange of clinical risk factors complicating prenatal care from obstetric provider; 4) communication between the doula and provider; 5) educating the obstetric team on benefits of doula support; 6) preparing labor and delivery team for presence of doula during labor ; and 7) enhancing doula support postpartum for cardiovascular risk reduction.
|
An integrated model of community-based doulas and clinical obstetric providers
|
Active Comparator: Usual Care
Standard of care for pregnancy and pregnancy-related issues will be provided by the obstetric provider as per routine.
|
Standard of care for pregnancy and pregnancy-related issues by the obstetric provider
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Perinatal Healthcare Engagement
Time Frame: From study enrollment and until 12 months postpartum
|
A composite of the following variables to assess perinatal healthcare engagement: 1) Attended at least ~75% of the recommended prenatal visits; 2) Attended postpartum visit; 3) Received recommended vaccination during pregnancy.
|
From study enrollment and until 12 months postpartum
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Trust in Provider
Time Frame: Baseline; third trimester, and postpartum
|
A validated 11-item instrument used to measure patients' trust in the provider regarding dependability, confidence, and confidentiality of information.
|
Baseline; third trimester, and postpartum
|
Reported Discrimination
Time Frame: Baseline, third trimester and postpartum
|
Measured with a validated survey of patient self-report on how often in the past 12 months, individuals felt treated poorly due to race.
|
Baseline, third trimester and postpartum
|
Perceived Stress
Time Frame: Baseline, third trimester and postpartum
|
Measured with Cohen's Perceived Stress Scale
|
Baseline, third trimester and postpartum
|
Depression
Time Frame: Baseline, third trimester and postpartum
|
Measured with the Patient Health Questionnaire-9 (PHQ-9)
|
Baseline, third trimester and postpartum
|
Cesarean birth
Time Frame: At study completion
|
Cesarean birth for any indication other than prior cesarean
|
At study completion
|
Unplanned healthcare utilization
Time Frame: Up to 12 months postpartum
|
Prenatal or postpartum (up to 12 weeks postpartum) unplanned emergency room visits or hospitalizations.
|
Up to 12 months postpartum
|
Severe Maternal Morbidity
Time Frame: Up to 12 months postpartum
|
Composite outcome of the following diagnoses using ICD-10 codes: acute myocardial infarction, aneurysm, acute renal failure, adult respiratory distress syndrome, amniotic fluid embolism, cardiac arrest, disseminated intravascular coagulation, eclampsia, heart failure, puerperal cerebrovascular disorders, pulmonary edema, severe anesthesia complications, sepsis, shock, sickle cell disease with crisis, air and thrombotic embolism blood products transfusion, hysterectomy, temporary tracheostomy, ventilation.
|
Up to 12 months postpartum
|
Breastfeeding Initiation
Time Frame: Up to 12 months postpartum
|
Rates of breastfeeding initiation prior to discharge from the hospital
|
Up to 12 months postpartum
|
Group-Based Medical Mistrust Scale
Time Frame: Baseline; Week 27 up to birth (third trimester); Birth up to Week 40 (Postpartum)
|
A 12-item validated survey focused on healthcare provided in the social context of racism and discrimination.
|
Baseline; Week 27 up to birth (third trimester); Birth up to Week 40 (Postpartum)
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- PRO00047801
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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