Rationale and design of the A-STAC study: A multi-stage, hybrid effectiveness-implementation trial to prevent and reduce racial disparities in postpartum hypertension.

BACKGROUND: Hypertensive disorders of pregnancy are a leading cause of maternal and neonatal morbidity and mortality and are 60 % more common among Black birthing people than non-Black birthing people. Staying Healthy After Childbirth (STAC) is an evidence-based healthcare program that increases healthcare access by providing postpartum patients with a home blood pressure monitor and a healthcare team that remotely monitors and treats hypertension. This study adapts STAC to expand program reach for Black birthing people via implementation in community-based organizations.

METHOD: The study team is partnering with community-based organizations led by and/or serving Black birthing people and Black individuals with lived experiences of hypertension during pregnancy to inform care model adaptation. Guided by the Replicating Effective Programs Framework, the study will be conducted over three stages. The pre-implementation stage will consist of identifying adaptations to STAC to align with community values and priorities. We will apply these adaptations in rapid Plan-Do-Study-Act implementation cycles to create a finalized adapted STAC (A-STAC) program. The implementation stage will consist of delivering A-STAC through community-based organizations and evaluating A-STAC effectiveness, reach, and adoption. The maintenance and evolution stage will consist of identifying strategies for sustainment of A-STAC.

CONCLUSION: This adapted intervention has the potential to decrease disparities in postpartum morbidity and mortality for Black birthing people and enhance generational health equity.