Using a combined Centering Pregnancy/ social network (“Tupperware”) strategy as a means to promote integrated maternal and perinatal care among vulnerable populations

Dutch perinatal mortality rate is relatively high. The promotion of a healthy lifestyle and early risk detection before conception may effectively prevent the Big4 conditions in pregnancy (i.e. premature birth, birth defects, low birth weight, low Apgar Score). Integral maternity care entails the period from preconception to the first six weeks after birth. This includes the collaboration between professionals (e.g., the midwife, obstetrician, pediatrician, GP, youth health care) and, if needed, referral to other professionals (including the social domain). Integral care has a holistic, positive health approach, focusing on a broad spectrum of care including future pregnancies and parenting and issues related to physical, mental health as well as social and financial barriers. Thus far, it is difficult to timely reach future parents, especially vulnerable couples (i.e. those with limited health literacy skills, low socioeconomic status (SES) or a migrant background). Future parents are those with a (re-)new(ed) child wish. To increase the reach, including vulnerable women, and to improve integrated care concerning pre- and interconception care, we propose a combined strategy using (a) the Centering Pregnancy (CP) methodology with (b) a social network strategy (also referred to as the Tupperware strategy). CP group members often continue to meet after pregnancy. Existing CP groups could be a starting point for interconception care, and a channel for reaching new (future) parents. We propose to use CP as a means to deliver integrated care, as well as a social network strategy to effectively reach and motivate other peers, family and friends with a potential child wish to participate. RELEVANCE CP is an evidence-based group care method that effectively reaches vulnerable pregnant women. It generates group and community building, shared identity and trust, which foster strong bonds amongst group members and with the CP caregivers, continuing even after pregnancy. CP facilitates public health, and with the use of a social network approach (referred to as 'Tupperware' strategy), future parents can be reached via CP members. PROPOSED INTERVENTION CP consists of 10 group sessions, guided by maternity caregivers. The project will consist of one extra (11th) CP meeting (e.g., 3-6 months) after birth. This subsequent meeting would be an extra opportunity for integrated interconception and health care, involving a midwife and youth health care/social care professionals. Furthermore, it is an opportunity for CP members to invite their network ((future) parents) for this extended CP meeting, thereby increasing the reach to future parents who otherwise might be unlikely to attend. Topics of interest regarding health and social domains, raised by participants, will be discussed (e.g., PCC, diet, parenting, financial problems), facilitated by relevant professionals. Necessary referrals are based on local social service guides and the Preconception Indication List (PIL) which are both part of the Standard Integrated Maternity care (ZIG). Intermediate- and end users are involved to co-design implementation strategies and adapt them where necessary. PROJECT AIM AND RESEARCH QUESTIONS The project aims to promote integrated pre- and interconception care by developing a social group and network strategy (Tupperware), based on existing CP groups and the input and collaboration of CP group members. 1. To what extent does the Centering/Tupperware strategy reach future parents in order to effectively promote preconception care (PCC) and interconception care (ICC), including vulnerable populations (low SES, migrant background, and those with limited health literacy skills)? 2. To what extent does the proposed strategy promote integrated care, i.e., promote collaboration between professionals from different health and social welfare domains? 3. How is the additional (11th) CP group meeting appreciated by participants, and how does this meeting contribute to awareness of PCC related behaviors (e.g., diet, not smoking, folic acid intake) and overall positive health of (future) parents, as well as pregnancy planning? PROJECT PHASES (48 months) 1. systematic user-centered strategy development (18 months): i.e. setting up a linkage group, understanding user needs/requirements, development and pre-testing, and feasibility study; 2. intervention pilot (18 months); 3. data analysis, reporting and conference workshop (12 months).