NPM-1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year

Annual Report FY21:

This Performance Measure was NOT achieved. The Performance Objective was 67.5% and the Annual Indicator was 67%.

Program Activities:

In 2021, the Maternal and Infant Health Program (MIHP) utilized the social media platforms Facebook and Instagram to share information on preventive health care visits and women's health. These messages were shared under the Power Your Life logo and branding and used the handle @poweryourlifeut, in an effort to ensure content on both platforms would be easily identifiable and recognized as a trusted source. Approximately 70,000 people saw at least one post from the Power Your Life social media platforms, and this is nearly double the number of people exposed to Power Your Life content in 2020.

Nickee Andjelic, the certified health education specialist for the Maternal and Infant Health Program (MIHP), did an on-air television spot encouraging women to schedule their well-woman visit, especially if they had been putting it off during the COVID pandemic. This spot was aired during the afternoon news. The news station website posted a link to the segment and a brief written article about well-woman visits.

Due to the ongoing COVID pandemic, many of the yearly community health fairs and other community events MIHP participated in were canceled. However, we fostered new partnerships that allowed us to safely provide educational material to the public. As seen in the list below, MIHP staff provided material and resources to a wide range of community partners. It reached diverse populations of men, women, and young adults with messages about routine preventive care, preconception health, contraception, and birth defects prevention.

• Birth Defect Prevention Month: During National Birth Defects Prevention Month, MIHP and the Utah Birth Defects Prevention Network provided informational packets to three Local Health departments and WIC clinics. We provided 450 educational packets.
• Park City People's Choice Clinic: Educational materials and prenatal vitamins were provided to women who attended the clinic's wellness classes. We provided 100 packets to the clinic.
• Spring PopUp Mom Boutique: This event was held to support maternal mental health. We reached 250 people at this in-person event.
• Valley Health and Wellness Fair: This fair is targeted to people in an under-resourced area in the Salt Lake valley. They provide information and resources for a wide variety of community health organizations. We reached approximately 150 people at this event.
• Out of the Darkness Walk: This yearly event brings awareness to maternal mental health. We provided 150 educational packets to the group that sponsored the event for distribution to attendees.
• Islander Health Fair: This event is held yearly by the Pacific Islander Health Coalition. MIHP staff provided materials to an estimated 100 people.
• Partners in the Park: Sponsored by the University of Utah, this community event brings resources to residents on the west side of the valley, a high-need area. We talked about women's health and shared resources with about 100 people at this event.
• Utah Block Party: This health fair was for University of Utah students living in married housing. MIHP staff provided resources to and answered questions from the nearly 100 people that attended.
• Utah Valley University (UVU) Student Health Fair: UVU Student Health Services sponsors this bi-annual health fair to provide students with information and resources to improve their health and wellness. MIHP staff provided educational packets and other swag to the organizers of these health fairs, reaching approximately 150 UVU students and faculty.

While we do not know if any of these activities directly impact a woman seeking routine preventive care, our ability to meet our target population where they are, talk with them, and answer their questions face-to-face makes a difference in their knowledge and attitudes. During these health fairs, Ms. Andjelic has had meaningful conversations about contraception, when a person should seek a Pap test, and how certain lifestyle behaviors affect immediate health and the health of a future pregnancy with our target population.

The Power Your Life social media accounts, run by Ms. Andjelic, are a trusted source of information. Our followers regularly reach out through direct messaging on the platforms to ask questions and seek more information. In 2021, Ms. Andjelic continued partnering with the Salt County Health Department and the Utah Home Visiting Services and Support Program to provide Power Your Life educational booklets to its home visiting programs. These booklets are geared towards women of reproductive age and are easy to read and understand. Education in these booklets includes evidence-based practices and facts on vitamins, nutrition, preventive care, family history, vaccinations, sleep, healthy relationships, the menstrual cycle, sexually transmitted diseases, mental health, tobacco, alcohol, and birth control methods.

Finally, the MIHP program began regularly meeting with women's health and public health experts to work on a state strategic plan to increase the percentage of women of childbearing age that receive a well-woman visit.

Accomplishments/Successes:

Significant success is the ongoing relationships the MIHP program has developed with community organizations. For example, lasting relationships with Utah Valley University and the University of Utah have provided us an opportunity to reach thousands of women with health messaging through yearly health fairs. These relationships have remained strong throughout the COVID-19 pandemic, and we look forward to continuing working with them when it is safe to do so.

Another success is the inclusion of a question on the Utah Behavioral Risk Factor Surveillance System survey about why women of childbearing age who did not receive routine preventive care in the past year. This question is being asked to all women between 18-and 44 on the 2022 questionnaire.

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM - 1:

• Ongoing, mutually beneficial relationships with a local university, Utah Valley University, has allowed the Maternal and Infant Health Program (MIHP) to reach thousands of college-aged women with education and information about the importance of routine preventive care.
• Strong community partnerships allow us to distribute Power Your Life booklets to a wide network of women across the state. We are seen as a trusted resource at numerous community health fairs. Additionally, well-educated and approachable staff at these health fairs allows for education to happen on the spot.
• Successfully added a question to the 2022 Utah Behavioral Risk Factor Surveillance System about why women of childbearing age did not receive routine preventive care in the last 12 months.

Challenges/Gaps/Disparities Report:

Challenges:

The primary challenge faced by MIHP staff during FY21 continued to be the COVID-19 pandemic. Due to federal, state, and local ordinances, all large group gatherings, like health fairs, were canceled for the safety of all citizens. This led to MIHP staff being unable to attend as many health fairs as in previous years, thus resulting in lower numbers of people who were reached. We also anticipate a decrease in the percentage of women of reproductive age seeking routine preventive care in the next year due to the pandemic.

A secondary challenge of creating an evidence-based strategy for increasing the percentage of women receiving a well-woman visit is our inability to pinpoint why a woman does not schedule a yearly well-woman exam. Without this knowledge, we cannot create messages or programming that will address the needs of our target population. However, with the inclusion of a new question addressing barriers to routine preventive care on the 2022 Utah Behavioral Risk Factor Surveillance System survey, we are hopeful that future programming efforts will be able to use the data collected to create the messages that target the needs of our population.

Agency Capacity/Family Partnerships/Collaboration:

This work has been accomplished through agency partnerships with the Utah Birth Defect Network, Maternal and Infant Health Program, WIC, MotherToBaby, and Baby Your Baby.

The Utah Birth Defect Network (UBDN) is a significant partner for this performance measure. Staff from UBDN attend all health fairs with the Maternal and Infant Health Program staff. Program staff work together and often share resources and educational material. Both programs also use their respective social media accounts to share messages about preconception/women's health.

Another vital partner, MotherToBaby Utah (MTB UT), provides information to women about exposures in the preconception period, during pregnancy, and during breastfeeding. In FY21, MotherToBaby Utah answered questions from 458 women and their providers about exposures as they were planning for future pregnancies, 3,080 questions during pregnancy, and 2,132 questions before and during breastfeeding. MTB UT provides information about immunizations, chronic conditions, medications for chronic diseases, prenatal vitamins, and other exposures that might affect the developing fetus or breastfed baby to help women plan for their pregnancies, manage their conditions, and initiate and continue breastfeeding.

Report of ESMs related to NPM-1

ESM 1.2 - The number of home visiting clients that receive education on the well-woman visit from Salt Lake County Home Visiting Program staff.

Goal/Objective:

Increase the number of home visiting clients that receive education on the Well-Woman Visit.

Significance of ESM 1.2:

A trusted professional, like a home visitor is an effective messenger on the importance of a well-woman visit. Educating and encouraging home visiting clients to schedule and attend a well-woman exam can help them maintain a healthy lifestyle and minimize health risks.

ESM 1.2 Progress Summary:

Routine preventive care is key to health across the lifespan. A yearly preventive checkup is a time for a person to develop a trusting relationship with their healthcare provider and an opportunity for healthcare providers to counsel people on their specific healthcare needs and screen for early detection and treatment of disease and illness. The importance of routine preventive care was further addressed in the Affordable Care Act, requiring all insurers to cover 29 preventive services for women, including pregnant women (https://www.healthcare.gov/preventive-care-women/).

During this fiscal year, MIHP staff worked with home visiting staff to educate their clients on women's health and routine preventive care. A booklet called Power Your Life Power Your Health was given to female home visiting clients during their initial visit. These booklets include nutrition, exercise, routine preventive care, family health history, sleep, relationships, sexual health (menstruation, STDs, and contraception), and mental health information. A challenge of this ESM is that we do not have a robust evaluation strategy to measure the effectiveness of providing the Power Your Life booklet to home visiting clients. While we handed out 300 booklets to home visiting clients, we do not know if they effectively encouraged women to seek routine preventive care or a well-woman visit. Therefore, we plan to discontinue this ESM moving forward.

 

ESM 1.3 - Number of community partners and organizations engaged in coalition to create a well-woman visit strategic plan for the state of Utah.

Goal/Objective:

Engage a diverse group of community partners and organizations to develop a strategic plan to increase the percentage of women of reproductive age that reported a well-woman visit.

Significance of ESM 1.3:

Public health issues are best addressed by developing and sustaining partnerships between community organizations, medical experts, and government. Programs that develop and sustain these partnerships provide opportunities to improve the health of women during her lifespan.

ESM 1.3 Progress Summary:

MIHP recognizes that increasing the percentage of women that receive a well-woman visit is a goal that will take work from professionals in the healthcare field, public health, and community organizations. The MIHP began working with diverse stakeholders to create a statewide strategic plan to address routine preventive care in women of reproductive age during this fiscal year. A well-woman coalition was convened in January 2021 with members from public health, healthcare, rural health, and higher education. Stakeholders from each of these organizations regularly attend and participate in the meetings held every other month.

Currently, we are in the final stage of writing the strategic plan and anticipate it being completed in 2022. A previous statewide women's coalition has begun meeting after a couple of years of hiatus. Many of the same members of this well-woman coalition attend this meeting. Since we do not want to duplicate efforts, we will be discontinuing this coalition after the strategic plan is complete. However, work toward improving women's health throughout the state will continue through this previously established women's coalition.

ESM 1.4 - Add additional question(s) on the Utah Behavioral Risk Factor Surveillance Survey (BRFSS) to learn more on the facilitators and barriers to women receiving routine preventive care.

Goal/Objective:

Increase the number of questions on the Utah BRFSS so we can better understand the barriers and facilitators to women in obtaining a well woman visit.

Significance of ESM 1.4:

Success of public health messaging must include input from the population it is trying to reach. Using the Utah Behavioral Risk Factor Surveillance Survey (BRFSS), program staff will be able to ask a diverse group of women on the facilitator and barriers to receiving a well-woman visit. With this information it is possible to create programming that will resonate with our target population, thus increasing the percentage of women who receive care.

 

ESM 1.4 Progress Summary:

A challenge in creating an evidence-based strategy for increasing the percentage of women receiving a well-woman visit is our inability to pinpoint why a woman does not schedule a yearly well-woman exam. Without this knowledge, we cannot create messages or programming that will address the needs of our population. To address this challenge, MIHP successfully added a question to the 2022 Utah Behavioral Risk Factor Surveillance Survey, asking women of reproductive age why they did not receive routine preventive care in the last year.

The question the MIHP added follows the core question CHCA.04, "About how long has it been since you last visited a doctor for a routine checkup?" If a woman aged 18-44 answers anything other than "Within the past year (anytime less than 12 months ago), they are asked our added question. This follow-up question is, "You stated that you had not visited a doctor for a routine checkup in the past year. What are the primary reasons you did not receive a checkup?" Possible answers include: (1) I did not know that I needed a yearly routine checkup (2) I could not get an appointment when I wanted one (3) I had no way to get to the clinic or doctor's office (4) I could not take time off from work or school (5) I had no one to take care of my children (6) I didn't want to visit a clinic or doctor's office due to COVID (7) Other (8) Don't know/Not Sure (9) Refused. Because we have successfully completed our objective of adding a question to the BRFSS, we will deactivate this measure as data is currently being collected.

ESM 1.5 - Develop and offer an educational module to community health workers as an online supplemental course.

Goal/Objective:

Creation of a Maternal and Child Health education module that will be available online that will focus on preparing community health workers (CHWs) to educate on preconception health and well-woman care recommendations.

Significance of ESM 1.5:

By reaching and mobilizing women of childbearing age within their communities, community health workers can improve access to care and increase utilization of preventive care services like cervical cancer screenings and mammography. By focusing on well-woman care, trained CHWs have the potential to protect and optimize women’s health over the course of their lifetime and reach our underserved communities.

ESM 1.5 Progress Summary: Because this is a new ESM we will be collecting baseline data in FY23 and will be able to report in next year’s application and report.

Local Health Department Activities related to NPM-1:

There are two Local Health Departments (LHDs) who work on activities for NPM 1 – Well-Women Visits. One LHD was able to provide 5 IUDs to women that reported they would have otherwise gotten pregnant or had less money for basic needs. They were also able to help 51 women receive well-woman exams that they otherwise would not have received. One LHD has contracts with local pharmacies to dispense the birth control methods that they offer. During home visitation visits and WIC appointments women are educated on the importance of women's health, pregnancy spacing, and birth control options. Referrals are made to those that cannot afford to pay for their prescription. One LHD was able to provide 62 Depo Provera injections, 19 cycles of oral birth control, and 17 NuvaRing prescriptions.

SPM-1: Percent of mothers that report a doctor, nurse or other health care worker asked if they were feeling down or depressed during prenatal and postpartum care

Annual Report FY21:

Program Activities:

This Performance Measure was NOT achieved. The Performance Objective was 63.8% and the Annual Indicator was 60.0%.

During FY21, the maternal mental health (MMH) specialist in the Maternal and Infant Health Program (MIHP) conducted numerous trainings and presentations to raise awareness about perinatal mental health in Utah and increase knowledge of the Maternal Mental Health Referral Network, a listing of mental health providers with training in perinatal mental health. Presentation audiences included the Syringe Exchange Network, local health departments, local mental health authorities, staff in the Division of Substance Abuse and Mental Health, home visitors, staff in the Office of Health Disparities and their program volunteers, the Utah Suicide Prevention Coalition, clinical staff in multiple practices, and WIC staff.

Additionally, presentations on the Maternal Mental Health Referral Network were given at national meetings such as the Marce Society’s annual conference and Postpartum Support International’s bi-monthly summit. The MMH specialist also promoted awareness of perinatal mental health conditions and resources via Instagram and Facebook.

In May 2020, the Utah Department of Health established a maternal mental health Instagram page and by March 2021, the page had over 11,000 followers. With the success of the Instagram page, permission was given to also launch a Facebook page in November 2020. This page had over 1,800 followers by April 2021. The MMH specialist participated in several media events including podcasts, newspaper articles, TV news segments, and social media livestreams. The MMH specialist also participated in Black Mental Health week online to promote awareness and resources.

The Maternal Mental Health Referral Network continued to be promoted in all settings. The MMH specialist worked to encourage providers who were trained in perinatal mental health to list their services on the site to increase available services statewide. The Maternal and Infant Health Program continued to contract with the University of Utah, College of Nursing to address the mental health needs of childbearing women in rural and frontier Utah geographic areas that are designated as Health Professional Shortage Areas for mental health. Through this project, screening for depression among pregnant and postpartum women, using a validated screening tool, is offered through local health departments. Women who have a positive screen for perinatal depression are offered resources in the form of handouts, support groups, or individual mental health services via a telehealth platform. In this time period, the Maternal Mental Health Subcommittee of the Utah Women and Newborns Quality Collaborative worked on development of a maternal mental health screening and referral toolkit. Data related to perinatal mental health was compiled by PRAMS staff and a report, “Maternal Mental Health in Utah”, was published on the Maternal and Infant Health program website: https://mihp.utah.gov/wp-content/uploads/Maternal-Mental-Health-Utah-PRAMS-2016-2019.pdf.

MCH staff participated in the Utah Maternal Mental Health Collaborative. This group focused on policy issues surrounding maternal mental health and activities to raise awareness of the issue in Utah. The collaborative includes stakeholders from a wide range of agencies who serve Utah’s women and children. Utah Governor Spencer Cox also declared February 2021 as Maternal Mental Health Awareness month. The Utah Maternal Mental Health Collaborative held an event on February 17, 2021 to mark this declaration which generated media coverage. There was a noted increase in the number of visitors (February 17th –19th) to the Utah Maternal Mental Health Referral Network (https://maternalmentalhealth.utah.gov/).

MotherToBaby Utah provided information about exposures, including mood medications, in pregnancy and breastfeeding to help reduce untreated mood conditions, prevent exposures that increase risks for birth defects and developmental delays, prevent other adverse pregnancy outcomes, and increase breastfeeding rates.
 

Accomplishments / Successes:

A noted success is increasing awareness of the Maternal Mental Health Referral Network. The site has been promoted through training and social media. The site is now linked on the Utah Medical Home Portal and the Postpartum Support International Utah Chapter's webpage.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to SPM-1:

• Conducted educational training to raise awareness around perinatal mental health.
• Published a PRAMS Perspectives report, "Maternal Mental Health in Utah"
• Launched Instagram and Facebook pages.

Challenges / Gaps / Disparities Report:

Challenges:

The 2020 PRAMS data was collected during the COVID-19 pandemic. The PRAMS data found that the percentage of women who did not attend a postpartum visit increased from 8% in 2019 to 11% in 2020. This is not an unexpected finding with the impacts the pandemic had on the healthcare system and concerns for pregnant and postpartum women related to avoiding infection from the virus. It is anticipated that the effects of the pandemic will continue to be seen in the 2021 data. Also related to the pandemic was adjusting to remote work in this reporting period. Many opportunities for training were canceled or delayed due to adjusting to a virtual work environment.

Agency Capacity / Collaboration Report:

Critical partners in this work are staff in the Division of Substance Abuse and Mental Health. With the merging of the Utah Department of Health and the Department of Human Services, we anticipate these partnerships to be strengthened.

 

Local Health Department Activities related to SPM-1:

Eight of Utah’s 13 Local Health Departments worked on strategy measures and activities to improve outcomes for women experiencing postpartum depression (SPM 1). There were many successes during the year, in spite of the continuing challenges related to COVID. Many staff were trained on the Edinburgh Postnatal Depression Scale (EPDS) screening tool and how to educate women who screen positive. Screenings were offered in the places where clients connect with the LHD, through WIC programs, Parents as Teachers home visiting sites, and Targeted Case Management (TCM) visits. As part of these visits, a postpartum assessment/depression screening (EPDS) was offered. Unfortunately, many LHDs saw significant decreases in women who were willing to participate. Most LHDs did not screen the number of women they had planned, but accommodations were allowed due to COVID.

Upon completion of the EPDS, nurses would score results immediately and anyone who scored ≥10 would be provided a mental health service referral. At least one of the LHDs also implemented an Adverse Childhood Experiences Screening (ACEs). Clients served in the MCH program are at higher risk of scoring ≥4 on an ACEs questionnaire and are an essential group to target interventions. Parents/caregivers visited through home visitation programs were also offered the ACE screening tool and other ACEs & Resiliency information materials. If the ACE questionnaire was done in person with the nurse, the results were reviewed with the parent/caregiver. Those scoring ≥4 were also provided the Resilience assessment to help the client identify their existing support systems and were linked to needed supports/resources. During the grant year, 37 ACEs screenings were performed at this particular LHD and although this is a small number, it still identified individuals/families at risk and provided a venue for interventions. The interesting fact is that more women were willing to do the ACEs screening than were willing to complete the EPDS.

Davis County LHD’s report sums up most experiences that occurred statewide for all the LHDs.

“With the COVID pandemic still actively occurring in Utah, the US and globally - many public health services continued to be suspended and efforts redirected towards the Coronavirus pandemic work. As a result, the MCH objectives planned for the 2020-2021 grant year here in Davis County were greatly affected. In fact, it was more impacted this grant year than the previous year due to the fact that the grant year began and ended during the most significant and hardest hit months of the pandemic. All nurses who would normally be performing the post-partum depression screenings were reassigned to COVID response efforts. As a safety precaution, no home visits were performed most of the months during the grant year of October 2020 - September 2021. In addition, the COVID vaccine was approved under an FDA EUA in December 2020. The burden of vaccinations fell upon public health. Since nurses are licensed to administer vaccines, they were allocated to the vaccine response efforts. The heavy COVID vaccine efforts continued for several months into 2021 until other venues were able to onboard and start delivering the COVID vaccines as well. In Utah, we also experienced a decrease in cases during the summer months. At this time, 1-2 MCH nurses were able to start providing services to the Davis County community again. Due to some amendments with the Medicaid contracts, our MCH nurses were able to get telehealth appointments up and running. This method was successful in performing services for the infant/child, but less effective in assessing the mothers. Therefore, less women were willing to do the postpartum depression screenings. As cases increased again with the start of school and with the new guidance on COVID booster vaccines, the MCH nurses were once again redirected to the COVID efforts and MCH services were halted. It is unsure when services will be able to resume.”

For many LHDs staff turnover was a huge issue and finding replacements was a challenge. Either there were not enough nurses in the community who would apply for open positions or many times LHDs were not able to compete with the wages hospital positions were paying and nurses left for a higher salary. Once staffing levels return to “normal” staff will be trained on the EPDS tool and implementation for clients back in place.

For many LHDs, offices were closed most of the year to in-person Targeted Case Management (Medicaid), Parents as Teachers (Home Visiting) and WIC appointments. As you would expect, seeing clients in person was a challenge. While many implemented telehealth appointments there were still challenges. Many clients would not answer phone calls or keep their appointments. Many times longer wait times and decreased access to services made participation worse even though many schedule adjustments were made to accommodate clinic and client needs. During the year quarantine guidelines changed and staffing returned to somewhat normal. This has allowed for in-person appointments once again. There is hope for the LHDs that there will be an increased number of women being screened using the EPDS.

 

Other activities in the Women’s Health domain that contribute to improvement in the National Outcome Measures

Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpire in parallel. The following programmatic activities also work to improve outcomes in this domain.

National Outcome Measures (NOM)

NOM 1: Percent of pregnant women who receive prenatal care beginning in the first trimester

The Baby Your Baby Outreach Program encourages women to receive early and adequate prenatal care through TV, radio, podcasts, and social media. In 2020 and 2021, several spots were created to provide expectant women on how to be safe during the pandemic. The Baby Your Baby Program updated their website to be more modern and easier to use. Podcasts continue to increase in popularity as more topics are added.

MotherToBaby Utah helped reduce maternal morbidity by providing information about exposures in pregnancy and breastfeeding to help reduce untreated conditions.

NOM 2: Rate of severe maternal morbidity per 10,000 delivery hospitalizations

Utah is a member state of the Alliance for Innovation on Maternal Health and works to implement maternal safety bundles. Hospitals have been working in past years to implement the hemorrhage and hypertension safety bundles. In 2019, hospitals voted to begin work on implementation of the Obstetric Care for Women with Opioid Use Disorder safety bundle. In FY21, learning sessions were presented on the following topics related to the safety bundle:

• Polysubstance Use During Pregnancy: Meth and Marijuana
• Neonatal Abstinence Syndrome and Newborn Care
• Validated Screening Tools
• Patient and Family Education and Resources
• Medications and Treatment Response
• Rural Access and Resources
• Opioid Use Disorder Patient Interaction
• Patient Interactions - Tips and Techniques
• Family Planning
• Naloxone and Utah Support Advocates for Recovery Awareness

Work on the AIM Care for Pregnant and Postpartum People with Opioid Use Disorder Safety Bundle included compiling and mailing Helping Opioid Patients Excel (H.O.P.E.) folders and Naloxone to all Utah hospitals and Home Visiting contacts. We translated into Spanish the Substance Use Disorder (SUD) resources and launched a Spanish SUD resources website. We created and published local SUD resources for 9 local health departments with the help of Title V summer interns, who presented their project at the Association of Maternal & Child Health Programs (AMCHP). We hosted a booth at the Utah Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) annual conference and our Maternal Mental Health committee chair presented and shared UWNQC info.

NOM 3: Maternal mortality rate per 100,000 live births

Utah has an established maternal mortality review (MMR) committee and all maternal deaths are brought to the committee for review and prevention recommendations. Utah receives Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE-MM) funding from the CDC. Utah partners with the State of Wyoming on this grant and a single maternal mortality review committee to review maternal deaths among residents of both states.

The Office of Health Equity published a report highlighting health disparities in maternal mortality and morbidity. This report (https://healthequity.utah.gov/wp-content/uploads/2022/02/UtahHealthDisparitiesProfileMaternalMortalityMorbidity2021.pdf) was published online.

The Office of Health Equity launched the EMBRACE project in 2021. The Embrace Project Study (Embrace) is a community-based participatory research study focused on addressing health in maternal mortality and morbidity and diabetes. Embrace was developed by the Utah Department of Health Office of Health Equity and the University of Utah Health’s The Wellness Bus in partnership with community health workers from community-based organizations. This study focuses on addressing maternal mortality and morbidity and diabetes health disparities among women 18–44 years old who are Native Hawaiian and Pacific Islander, Black/African American, Hispanic or Latina, and Refugee and new American along Utah’s Wasatch Front in Salt Lake, Weber, Davis, and Utah counties.
 

The aim of Embrace is to reduce health disparities among Native Hawaiian and Pacific Islander women by providing culturally responsive health services for the women in this study. Embrace focuses on mental health and self-care for women so they are able to thrive for their current and future generations. Embrace also roots mental and self-care practices in ancestral NHPI cultural traditions and emphasizes culture as a source of resilience.

Through the University of Utah Health’s The Wellness Bus (https://healthcare.utah.edu/wellness/driving-out-diabetes/mobile-health-program.php), a mobile health clinic which provides chronic disease screenings in key neighborhoods, the study is able to provide biometric screenings and health coaching sessions. Embrace is also partnered with five community-based organizations, National Tongan American Society, Utah Pacific Islander Health Coalition, Comunidad Materna en Utah, Project Success Coalition, and Utah Muslim Civic League, who each serve their community members. Embrace works and supports community health workers (CHWs) who are able to support and engage community members in the study.

The Embrace Project Study’s (Embrace) focus is diabetes and maternal mortality and morbidity health disparities among women from racial and ethnic minority backgrounds along Utah’s Wasatch Front. A unique aspect of Embrace’s curriculum is rooted in Native Hawaiian and Pacific Islander culture and traditions. One component that Embrace focuses on is mental health. Mental health is vital to the health and wellbeing of everyone, particularly among women of childbearing age in these communities. Providing education on mental health and self-care is essential for women in this study. Mental health continues to be stigmatized, and self-care is often seen through a narrow lens. This study focuses on mental health and self-care grounded in cultural practices and beliefs, reimagining and changing the narrative around what self-care should be, and expanding self-care to include everyone.

In FY21, Embrace had two cohorts of women participating in the study. Embrace began in April 2021, and is expected to end June-July 2022. The Embrace project was funded by the Community Program to Improve Minority Health (CFDA No 93.137) from the Office of Minority Health, Office of the Assistant Secretary for Health, Department of Health and Human Services, 2020 – 2022.