LaFave LA, Clemmons N, Kotelchuck M, Morales Cozier N, Geltman A, Browne DR, Kenyon K. Activating Life Course Theory through a Whole System Prevention Framework to Address the Wicked Problem of Maternal and Infant Morbidity and Mortality.
COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024;
44:349-364. [PMID:
37271730 PMCID:
PMC11143759 DOI:
10.1177/2752535x231170737]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND
Racial/ethnic disparities in maternal and infant morbidity and mortality (MIM&M) is a wicked problem that is reinforced and perpetuated by our system[s] of care. Life Course Theory (LCT) helps to explain drivers of health disparities, but its application is challenged. An upstream approach that promotes systemic change requires the implementation of an expanded prevention framework that includes primordial and quaternary prevention.
RESEARCH DESIGN
We developed an innovative expanded Whole System Prevention Framework (WSPF) that incorporates LCT, prevention (including primordial and quaternary prevention) and systems thinking.
STUDY SAMPLE
We implemented this new conceptual Framework with two Healthy Start community partnerships through training, service mapping, and strategic planning to address upstream drivers of MIM&M.
DATA COLLECTION AND ANALYSIS
Service mapping revealed few Healthy Start upstream activities/services with the predominance being delivered downstream at the program (microsystem) level.
RESULTS
Service mapping provided a snapshot of the current service distribution of services across the systems. The preponderance were primary, secondary and tertiary prevention activities (75.5% and 65.6%) delivered at the program level (58.2% and 68%), revealing opportunities for upstream strategies to promote equity. The implementation process provided a new way to frame strategic planning and develop upstream strategies to promote health equity and reduce MIM&M.
CONCLUSION
The Whole System Prevention Framework and its implementation methodology could be applied to address other wicked problems.
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