Reducing Preterm Births in Cincinnati
Working at the Business Innovation Factory and partnering with Cincinnati Children's Hospital Medical Center
Position: Lead Researcher and Experience Designer
Skills and Methods:
Participatory Design Facilitation
4 month project to understand the experience of pregnancy for women in Avondale, with the goal of presenting opportunities to lower the rate of preterm births in the community. I was the Lead Researcher and Experience Designer on this project, with support from my Director and a video team that helped me tell the story of these women to our stakeholders. Cincinnati Children's Hospital Medical Center, our client, won a Mayo Transform award for one our concepts, Neighborhood Feasts (see below) in 2015. Download the full project PDF here.
Avondale, a community in Cincinnati, Ohio, is experiencing extraordinarily high rates of preterm births–babies being born before 37 weeks of weeks of pregnancy. Avondale is also home to some of the best medical resources in the country, including Cincinnati Children's Hospital Medical Center. The innovation team at CCHMC commissioned us to find leverage points for improving outcomes.
We sought to understand the experience of pregnancy for women in Avondale and the human factors that contribute to their health, including their behaviors, values, and relationships. How is pregnancy viewed? What is important to do or not do while you're pregnant? Who can you rely on? How does the community understand preterm birth?
With the help of 16 generous women, 2 dads, and 19 stakeholders, we sought to understand the narrative of many women in Avondale. Women were interviewed for two hours, most in their homes. 2 Stakeholder interviews lasted one hour, diving into the stakeholders' perspective on the pregnancy experience and the community health ecosystem as whole.
We synthesized this narrative into the four human factors that have the power to change this paradigm, and generate better pregnancy outcomes. Without these mindsets, women may struggle in their pregnancy journey and in reaching their goal of having a healthy, full term baby.
Participatory Design Studio
With these insights in mind, we crafted a 2 day participatory design event where 8 of the women interviewed would come together with stakeholders from the community–including the hospital leadership team, pastors, doctors, and YMCA staff–to shape these opportunities into concepts for improving pregnancy outcomes.
10 ideas surfaced, that the group felt could make a real difference in improving outcomes. We categorized them into 3 approaches that are crucial to improving to improving the issue of preterm birth as a community. These concepts are only the beginning. The hospital, community members, and mothers have since formed a collective called StartStrong, and are currently prototyping and testing a number of these concepts in the communities.
Opportunities for Transformation
We need to move from relying on clinical, expert knowledge to imbuing our social networks with health knowledge. By creating new social connections among patients and doctors, nurses, staff, fellow mothers, and with members of the community, we create support networks, rooted in empathy and trust that can help women navigate pregnancy, motherhood, and health.
AGENCY IN CARE
We need to move from a system that delivers care to the sick to a model that promotes wellness. By changing the models for clinical care, we can support women as they make daily decisions around their health.
We need to move the responsibility of health from the doctor to the individual, shifting the control from institution to the citizen. By meeting women in their neighborhood and providing tools personalized for their lives, we can help them feel powerful, in control of their lives, and confident in the decisions they make about their own health and their family’s health.
Women, moms, families, community leaders, and providers come together to plan and host a neighborhood feast for themselves and a number of their peers. The community cooks and breaks bread together, sharing their stories and building new connections.
• Increases empathy and trust among neighborhood residents and resources
• Builds relationships and connections capable of collaboration
JUSTICE LEAGUE OF MOMS
Moms and moms-to-be design their own women’s group focused on developing their power as women and leaders in the community. Role models, mentors, and Justice League alumni provide inspiration and facilitate discussion as women develop charges for making a positive impact in their community.
• Increases leadership and ownership over community issues, creating a sustainable, bottom up approach to creating change
• Builds connections that will make meaning of and contextualize information
• Boosts capacity for reflection and proactive decision-making
• Exposes women to new narratives and provides the mentors to achieve a new future.
MOVEMENT TO PREVENT PRETERM BIRTHS
Women and moms from Avondale organize to develop and lead a campaign around preterm birth awareness. They leverage community organizations as well as their own social networks to spread the word.
• Uses a bottom-up approach that leverages and creates individuals as community leaders, making the campaign sustainable, meaningful, and relevant
• Delivers the message through trusted sources and an accessible platform
PROVIDER AS A PARTNER IN HEALTH
Creating ways doctors can partner with women in their care, not just prescribe them instructions. In this concept, the care team acts as partners in health for their patients, helping women set their own goals and providing tools for taking actionable steps and managing their own care in their daily life.
• Increases trust and communication between provider and patient
• Makes health tangible and relevant
• Adds an expert with trusted, quality knowledge to a woman’s support network
FAMILY CENTERED CARE
The care team works with an expectant mother and her support network, facilitating their discussion to define the family’s goals and actionable ways to achieve them. The care team provides tools for supporting the family’s progress at home.
• Involves a woman’s support network in her care
• Strengthens a woman’s support network with quality information and the ability to act
• Honors the importance of family
• Builds trust
Instead of 15 minute individual appointments, 8 women from diverse backgrounds, with similar due dates join the care provider for a group appointment. We can leverage the existing Centering Pregnancy program to incorporate woman and family centered principles.
• Social connection qualifies provider’s information, making it tangible, relevant, and rooted in stories of experience
• Women have exposure to new narratives, mentors, and form new social supports
• Builds empathy between doctor and patient by reversing power structure
• Allows providers more quality time with patients, making them less likely to “burn out”
• All women who attend prenatal appointments have the opportunity to form a social network with women “going through the same thing” and grow from all its benefits
• Providers can pull out common concerns and issues for expectant moms, then address them more directly
• Has been proven effective in reducing premature birth rates up to 41%
Staff within community organizations (like the library, recreation center, or churches) are trained in wellness information and neighborhood resources, and provide trusted guidance at sources convenient to women.
• Increased leadership and ownership over community issues
• Builds meaningful connections, contextualizes quality information,
• Draws on existing trusted resources to build collective community knowledge, creates convenient touch-points for care
MOBILE WOMEN'S HEALTH UNIT
Providers and wellness promoters team up in a mobile unit that goes to women’s neighborhoods to provide friendly and judgement-free guidance and access to birth control, health insurance, and social services.
• Expands touchpoints for care
• Removes myths and misinformation around birth control
• Provides a stigma-free venue for learning about and accessing birth control, giving women the tools to be powerful in how they plan their family and future.
• Gives women tools for spacing, planning, and preparing for pregnancy.
PERSONALIZED CONTINGENCY PLANS
Women and families works with a care provider or community wellness promoters to develop a personalized plan of what to do and who to call when they’re worried about their family’s safety or health.
• Equips families with the tools to make positive choices about their health and the resources they use, reducing primary care treatable Emergency Department visits.
REDUCING EMERGENCY DEPARTMENT VISITS
New tools such as a neighborhood resource map, a distribution strategy for resource information, and revised messaging for the after-hours line support personalized contingency plans and wellness promoters as primary capabilities for triaging non-emergent emergency department visits.
• Simple changes like these have been proven effective in a number of settings
• Creates tools that are relevant that people want to use