Christina Pacheco, J.D., MPH

Assistant Professor, Family Medicine and Community Health

Project Summary

American Indian/Alaska Native (AIAN) women experience significantly higher rates of maternal morbidity and mortality than non-Hispanic white women, with an increased prevalence of hypertensive disorders, gestational diabetes, and delayed prenatal care. Systemic challenges — such as limited access to contextually responsive care, geographic isolation, historical trauma and mistrust of medical providers — exacerbate the differences in maternal outcomes. Community Health Worker (CHW)-led interventions, combined with mobile health (mHealth) technology, hold promise for improving early health care engagement, self-management, trust and maternal health outcomes. This study applies an implementation science approach to evaluate the feasibility and effectiveness of recruitment strategies across three settings and will assess implementation outcomes — including reach, uptake, engagement and satisfaction — to inform future scalability and sustainability of Securing AIAN Futures through E-Health (SAFE). The community-tailored SAFE intervention combines CHW one-on-one support and education sessions paired with remote monitoring through the free Journey Pregnancy App. To ensure relevance and acceptability among pregnant AIAN women, SAFE will undergo a structured adaptation process that integrates AIAN knowledge, values and lived experiences. This study will generate critical preliminary data on feasibility of recruitment strategies, setting-specific referral processe, and engagement patterns, laying the foundation for a future NIH R01 evaluating SAFE’s effectiveness in reducing AIAN maternal health morbidity.

Our aims are three-fold:

1. Develop and refine SAFE, a community-tailored CHW-led intervention to support AIAN pregnant women.

2. Assess the feasibility of recruitment settings and strategies.

3. Evaluate reach, uptake, engagement and participant satisfaction of SAFE’s key components.