The THRIVE Project

We are researchers based at the University of Georgia, Athens, Georgia, United States.

The US has the highest preventable maternal deaths when compared to other developed country contexts. When disaggregated by race, Black women and birthing people (BWBP) are 3-5 times more likely to suffer pregnancy-related deaths compared to their White counterparts, even when statistically controlling for any differences in age, race, geographic location, education and pre-existing conditions. In some US states the differences in delivery hospitals explain as much as 60% of the Black-White maternal health disparity. Not coincidentally, Black birthing people are also much more likely to experience discrimination during the patient-provider interaction at the hospital.  BWBP are routinely ignored, under accommodated, misinformed by healthcare providers, and receive a paternalistic, often discriminatory model of treatment and care. BWBP without adequate and relevant information become additionally vulnerable to suffering related maternal complications or poor health outcomes.

Childbirth education classes are shown to significantly improve clinical outcomes, but they are less accessible to Black pregnant people due to reasons such as insurance status, lack of childcare and unreliable transportation. Institutional childbirth classes are not tailored and have not evolved over the past 20 years, despite the rapidly changing demographics of the United States. Less than 18% of expectant parents attend these hospital classes, and White women attend at double the rate of BWBP. In lieu of participating in hospital-based childbirth classes, BWBP tend to seek and access social support from family members, and require their mothers and other extended family members' presence during childbirth more than their White counterparts. Institutional childbirth education is not considered a priority for BWBP, who believe that they have innate knowledge and skills for childbirth, or can access this through female relatives and important others in their community. Social support from trained and untrained personal aides is associated with reductions in need for analgesia, Caesarean section, and increases in spontaneous vaginal delivery without interventions like forceps or vacuum extraction. Specifically, communication and advocacy strategies of Black doulas (lay birth attendants) may be an important source of support; recent evidence from our formative research suggests that these skills may be transferable to BWBP’s chosen birth companions (BC) for labor and delivery. There are, to the authors knowledge, no education interventions specifically targeting the persons who provide social support for BWBP.

In line with our promising pilot work, we will bridge the gap in communication, advocacy and education interventions for BC of BWBP. Our next step and the main focus of this proposal is to develop and evaluate a Train-the-Trainers online toolkit designed for BC (primary audience) and BWBP (secondary audience). We will partner with community leaders in the development of the toolkit, and they will, in turn, train the first BC’s (who can then train others and continue the cycle). The toolkit will be publicly accessible on the project website https://thethriveproject.org/. It will be integrated into the website but also accessible via a downloadable pdf. In addition, we will use artificial intelligence to pull additional blogs, videos, books, podcasts and documents, curated and mapped to our Conceptual model of Black Maternal Agency (B-MA). The AI- driven part of the toolkit will allow BWBP/BC to ask an open ended question and get a response based on our curated library of resources. In other words, the content will directly align with and acknowledge needs and preferences of BWBP at all levels of identity.

We aim to support over 500,000 BWBP who give birth annually in the United States by giving them and their BC’s tailored information to survive and thrive, despite a slow-changing healthcare system. The vast majority of expectant parents (98.4%) in the United States opt into standardized prenatal treatment and care within a hospital-based system, which does not offer tailored childbirth education. Our proposed toolkits can be used as a supplement in various maternal health education contexts, including traditional hospital classes. They can also be used by: (1) doulas and midwives clients who operate independently, and (2) companions of Black birthing people who encompass a possible range of individuals such as family, friends, partners, who may also be racially diverse. The fact that these assets are online means that they can be easily shared by BWBP with their chosen companions and care team. We believe that by developing and sharing innovations like this Train-the-Trainers toolkit, we believe we are contributing to a solution to the need for respectful and meaningful treatment and care that is required by BWBP.

This proposal is informed by the experience of our multidisciplinary research team in 1) designing culturally-targeted messages and interventions, 2) community-engagement and applied research methods 3) public health and epidemiology 4) psychology, social support and social technologies. We have an established relationship with our community partner, Uzazi Village, a nonprofit organization dedicated to eliminating maternal and infant health inequity among Black and Brown communities. Through education, support, and advocacy, Uzazi Village works to improve perinatal health in the Kansas City community and around the country.

We have an initial working version of a solution that we have collected, analyzed and written up: the feasibility and acceptability of our multimedia assets, available on our website (https://thethriveproject.org/). A total of 135 Black women and birthing people completed the survey; 14 participated in  follow-up interviews. We consider the stage to be a concept because the Train-the-Trainers toolkit will be an extension of this pilot tested work and made publicly available on this website, but it has not been designed yet.

The US Surgeon General published a call to action, which advocated for seamless communication accommodation from healthcare providers, and more involvement of women and their families in vocalizing their needs. Vice President Kamala Harris acknowledged racism in the US system as a cause of maternal health disparities, and on the provider side, funding was earmarked for implicit bias training. However, funding opportunities for interventions to support Black birthing people and their families’ skills in shared decision-making and advocacy have been much less visible. There is therefore a critical need to address this gap in interventions from an ecological perspective, and to center Black birthing people’s voices in the solution to the racial/ethnic disparities in pregnancy-related or associated morbidity and mortality. 

Funding the development and integration of the toolkit into the THRIVE platform supports the next stage of development and evaluation of our broader solution - an interactive learning platform for BWBP and their BC’s. This is directly in line with Solve and it's partners goals of education, equity, and innovation. In addition, we would benefit from expertise, mentorship and collaboration, particularly with healthcare system representatives who we would like to partner with to have sites for future research to establish the scientific evidence of this approach and for ultimate dissemination of the intervention.

This solution is innovative by integrating existing infrastructure within communities (familial social support and Black doulas’ knowledge on communication and advocacy) into one publicly available social technology (Train-the-trainers toolkit), which has the capacity to influence sustainable change (each trainee can then train others). Although intrinsically a practical solution, the intervention is novel because it is informed by communication theory (the Agency-Identity Model) that will be applied to real world settings, and using community-engaged methods to amplify local expertise and knowledge that can benefit the wider community of Black women and birthing people.

The THRIVE project theory of change suggests that acknowledging and intervening (tailoring) according to identity at every level (biological, intrapersonal, relational, and sociocultural) will lead to a decrease or elimination of unnecessary Black birth trauma (i.e. disempowerment, communication/medical dissatisfaction, anxiety/depression and other pregnancy-related illnesses). This relationship has been supported by our formative research with Black doulas (under review) and BWBP (see Wright, K., McFarlane, S.J., Francis, D. (2022). When race and agency collide: Examining pregnant Black women’s experiences in healthcare. Journal of Applied Communication Research Methods. https://doi-org.ezproxyberklee.flo.org/10.1080/00909882.2022.2083431). Our solution proposed here - an online Train-the-trainers toolkit -  involves (1) communication and dissemination to increase access to tailored information for BWBP  (2) Training and evaluation to strengthen capacity of BC of BWBP as change agents, who then train others to create a chain of influence and (3) following community-engaged research principles to effect sustainable social change.

Our long-term impact goal is to reduce health communication disparities affecting Black birthing persons during labor and delivery in the hospital. We define Black maternal health communication disparities as differences in the access to, amount and appropriateness of information, based on identity, that leads to unnecessary BWBP birth trauma (i.e. disempowerment, communication dissatisfaction, depression and other pregnancy-related illnesses). We will measure progress towards this goal by:

Short term (within the next year)

Increased access to tailored information and resources for BWBP

• Train-the-Trainers Curriculum & Toolkit for BC publicly available on THRIVE platform
• Publish evaluation data on curriculum and toolkit in peer reviewed journals 
• Present data on curriculum and toolkit at national academic conference

Strengthened capacity, collective efficacy, agency and influence of BC of BWBP as change agents to improve standards of treatment and care in hospitals

• Community leaders trained in Train-the-trainers Workshop & process evaluation conducted (N=10)
• Birth companions recruited and trained (via community leaders) and process evaluation (N=120)

Fostered a culture of community-engagement demonstrating community-researcher collaboration that enrich, addressing critical societal issue

• Increased communal resilience via trained BC workforce
• Community Advisory Board (CAB) created 
• Co-production of BC Curriculum & Train-the trainers toolkit

Long term (within 5 years)

Increased access to tailored information and resources for BWBP

• Curriculum and toolkit translated into a full suite THRIVE interactive learning platform for BWBP & BC
• Publish evaluation data on THRIVE learning platform in peer reviewed journals
• Present evaluation data on THRIVE learning platform at national academic conference(s)

Strengthened capacity, collective efficacy, agency and influence of BC of BWBP as change agents to improve standards of treatment and care in hospitals

• Pilot THRIVE with 2,000 Black pregnant people (e.g. via partnership within Kaiser Permanente, St. Marys, Piedmont, Grady) in a hospital-based randomized control trial.
• Hypothesis: BWBP exposed our intervention (THRIVE enhanced childbirth education) will report lower stress, anxiety, depression and improved childbirth experience and satisfaction compared to BWBP people who only received standard of care birth classes

Fostered a culture of community-engagement demonstrating community-researcher collaboration that enrich, addressing critical societal issue

• Increased communal resilience via trained BC workforce
• Community Advisory Board maintained
• Co-designed multimedia assets for THRIVE learning platform via iterative process

The train-the-trainers toolkit can be considered as a social technology - “a way of using human, intellectual and digital resources in order to influence social processes”. It will be available on our website and also downloadable as a pdf, but it’s power is in the way we imagine the community will use it. Peer-to-peer education is considered inclusive, participatory and appropriate for cultural tailoring of interventions. In addition, the AI supportive feature that allows open ended questions will require an AI plug in (annual license) for Wordpress site and a curated library from which to pull the answers.

Academic (6): This includes 4 faculty and 2 graduate students

Community Partner(2): Uzazi Village Community Expert Review Board (CERB); Center for Black Women's Wellness (Atlanta, Georgia)

Technology Consultant (1): Guard Up's Guardian Adventures (web hosting, web development, instructional design)

Total: 9 

My team has been working on this project for 4.5 years (began conceptualizing in July 2019).

This project is led by a Black woman, and the research team consists of all women, majority Black, with significant expertise in women’s health, health communication, health disparities, race/ethnicity and culture. We also include and welcome undergraduate and graduate students alongside faculty as a part of the mentorship structure of our research team.

Community-engaged methods are employed throughout the project, which includes partnership and oversight by the Uzazi Village Community Expert Review Board (CERB).  The research team aims to follow the values of community-engaged research, aiming to have true participation and representation of community expertise of the community throughout as much of the process as possible. As such, researchers are transparent about study objectives and share the study protocols and related documents for review and feedback with the CERB. The CERB is involved in finalizing the research protocols and recruitment material, leading participant recruitment, and in data analysis through member checking. Member checking (i.e, sharing initial findings for participant feedback) is conducted with the CERB to improve the production quality of the assets we develop and validity of the interpretation of final study results. The researchers maintain ongoing communication with the CERB. These regular meetings and consistent dialogue facilitates building an equitable and meaningful partnership between the researchers and community. For this proposal we’d like to have an in-person workshop with our community partners and to facilitate co-presentations and co-authorship of manuscripts resulting from this study.

We follow the academic/research route which involves a combination of securing intramural and extramural funding (e.g. National Institutes of Health; National Science Foundation), securing institutional ethical approval, conducting research and disseminating findings via scientific peer reviewed publications and academic conferences. We will ultimately aim to transfer the project intellectual property to a separate non profit entity, and aim to commercialize the THRIVE platform to scale-up and foster further societal and economic potential of the innovation.

We will seek extramural funding from the National Institutes of Health for a larger multi year grant to establish the THRIVE curriculum and platform as an evidence based intervention (e.g. NIH Director's Transformative Research Award). Once this is established we will transfer the intellectual property to a nonprofit organization established by the researchers that will lead implementation within health systems (e.g. Grady Hospital), who will pay for the platform access for their BWBP patients.

We have received funding of near to $150,000 from academic institutions for this project since November 2019, as outlined below:

1. Rapid Interdisciplinary Proposal (RIP), April - July 2024 (US$10,000)

2. Presidential Interdisciplinary Seed Grant Program Dec 2021 (US$131,982)

3. CSCA Federation Research Prize Jan 2020 - May 2020 (US$5,000)

4. UGA Faculty Seed Grant Program Nov 2019  ($1,500)