Abstract
Introduction
Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation.
Methods
ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes.
Results
107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes.
Discussion
Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.
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Data Availability
Available upon request.
Code Availability
Available upon request.
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Acknowledgements
The authors would like to thank Dave Goodman, PhD, MS from CDC for conceptualizing this study and Nicole Kosacz, MPH, who conducted the record linkage of Healthy Start program data, birth certificates, and Pregnancy Risk Assessment and Monitoring System (PRAMS) while working in the Georgia Maternal and Child Health Division at the Georgia Department of Public Health (GDPH), Atlanta, GA, at the time of the study. We also acknowledge the contributions of Jodi Hudgins, RN, MSN, Debra Griffin, MS, and the staff members of Enterprise Community Healthy Start, who provided and documented home visiting services to the participants in this study. We wish to also acknowledge the assistance of Peter Shipman, MLIS, Librarian at the Greenblatt Library, Augusta University, for checking citations and references and Dr. Barbara Dixson, Professor Emeritus, University of Wisconsin-Stevens Point, for editing the manuscript.
Funding
This research was supported in part by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under Grant number H40MC00129 from the Healthy Start Initiative, Maternal Child Health Bureau, Health Resources and Services Administration.
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The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, Health Resources and Services Administration, or the Centers for Disease Control and Prevention, nor does mention of the department or agency names imply endorsement by the U.S. Government.
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PRAMS data collection was approved by the GDPH Institutional Review Board (IRB) (Project #950601). This study was approved by the Augusta University IRB (Project #611346).
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Vladutiu, C.J., Mobley, S.C., Ji, X. et al. A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS, Birth Records and Program Data. Matern Child Health J 25, 1516–1525 (2021). https://doi.org/10.1007/s10995-021-03205-4
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DOI: https://doi.org/10.1007/s10995-021-03205-4