Understanding context: leveraging the pragmatic robust implementation sustainability model to inform the implementation of a community-based southeastern preconception counseling intervention to improve maternal health equity.

Abstract

Background: One major preconception risk driving poor childbirth outcomes in Black/African American women is cardiovascular health. Preconception counseling (PC) can reduce maternal health inequities, prevent fatal cardiovascular conditions, and improve the overall health of mothers before, during, and after pregnancy. This article examines contextual factors influencing the implementation of a community-based and culturally tailored PC intervention, ensuring equitable access amongst underserved populations.

Methods: We used the Practical Robust Implementation Science Model (PRISM) to guide a mixed-methods assessment among community partner sites to inform the implementation of a PC intervention for Black adults in the Southeastern U.S. We developed a regional accountability board (RAB) of community stakeholders and conducted a partner site survey (n = 10) to identify organizational characteristics and group interviews with site staff and community members that receive services at our partner sites.

Results: There was strong community and organizational buy-in for the PC intervention. Partner sites indicated moderate capability to implement PC; however, there was a need for enhanced infrastructure and organizational support for implementation, given limited experience providing PC and organizational funding, staff turnover, and lack of on-site medical services. Existing community trust and robust referral networks were major strengths among all sites.

Conclusion: Collaborative community partnerships engaged throughout this process surfaced key community priorities, strengths, and needs for PC implementation. Using multiple methods to gather community data and feedback informed iterative revisions to the implementation plans that have positioned partner sites to deliver culturally congruent PC to at-risk communities.