Mobile Integrated Care for Childhood Obesity (MICCO)
Research Project Leader: Thao-Ly Phan, MD, MPH
MICCO aims to improve the model of care for families of children with obesity living in rural communities by increasing access to evidence-based obesity care and tailoring obesity care to the needs of rural communities. Stakeholder-engaged and qualitative methods were used to refine the care model, which includes access to community-based resources to address family needs, visits with interdisciplinary specialists to establish healthy lifestyle goals, and tools to promote healthy lifestyle behaviors. Components of the intervention are enhanced by outreach from community health workers and a mobile platform integrated with the electronic health record.
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The care model is now being tested in a pilot randomized controlled trial with families from primary care practices in rural Delaware. Family engagement in care, child adiposity, and disparities in these outcomes will be contrasted between groups. The project aims to change practice paradigms by focusing on psychosocial determinants of childhood obesity, employing community-based resources and care navigators, leveraging Nemours’ state-of-the-art and user-friendly technology, and engaging stakeholders in all aspects of the project to ensure sustainable impact for families in rural Delaware.​
HEARTPrep: A virtually-delivered psychosocial intervention for mothers expecting a baby with congenital heart disease
Research Project Leader: Erica Sood, Ph.D.
HEARTPrep is an innovative psychosocial intervention for mothers expecting a baby with congenital heart disease (CHD), delivered in English and Spanish via mobile app. Following prenatal diagnosis of CHD, expectant mothers report high rates of stress (65%), anxiety (44%), and depression (29%). Perinatal mental health problems have far-reaching implications, influencing long-term maternal mental health, maternal-infant interaction, and child developmental trajectories. These effects are heightened in families with greater social and economic disadvantage. Psychosocial interventions are needed to improve maternal wellbeing following prenatal diagnosis of CHD. In Dr. Sood’s prior work, 88% of mothers reported they needed, but didn’t receive, psychosocial intervention targeting their unique needs following prenatal diagnosis. Spanish-speaking families experience even greater barriers to mental health care due to structural inequities that have worsened over the last decade.
Dr. Sood will refine HEARTPrep based on user feedback, determine whether HEARTPrep produces clinically significant improvements in maternal mental health (Proof-of-Concept), and conduct a randomized controlled trial with English- and Spanish-speaking mothers to evaluate preliminary efficacy. HEARTPrep has the potential to improve maternal wellbeing after prenatal diagnosis of CHD and alter perinatal mental health trajectories during a critical period for maternal-infant bonding and infant development. If determined to be efficacious, this model of psychosocial care could be adapted for other birth defects (3% of all births), given commonalities in maternal stress reactions and the disproportionate burden of perinatal mental health problems in disadvantaged groups.
Tech-Ex: A Peer Mentorship Program to Increase Equitable use of Continuous Glucose Monitoring Systems
Research Project Leader: Paul Enlow, PhD
This proposal will refine and evaluate the Technology Experts for Equity (Tech-Ex) intervention, which combines family mentorship (Technology Experts) with Technology Supports to address barriers to using CGM. Technology Experts, youth and caregiver mentors who are experienced with CGM, are well-equipped to help families learn about the benefits of CGM and problem-solve common issues. In Tech-Ex, their effectiveness is bolstered by support from the healthcare system, delivered through a state-of-the art mobile app (the Nemours App), that directly address other factors contributing to disparities in CGM use, such as limited access to culturally-tailored educational materials, poor patient-provider communication around problems with diabetes technology, and broader SDOH.
These Technology Supports include: a digital diary for families to facilitate patient-provider communication about CGM, culturally tailored educational materials, and screening for and addressing SDOH. Once refined, Tech-Ex will be evaluated in a pilot randomized controlled trial (RCT) guided by the Accelerated Creation to Sustainment Model, simultaneously evaluating effectiveness and implementation to enhance scalability and sustainability.