SAFE Futures: Supporting American Indian and Alaska Native (AIAN) Maternal Health through Virtual Engagement and Community Empowerment

American Indian/Alaska Native (AIAN) women experience significantly high rates of maternal morbidity and mortality, with an increased prevalence of hypertensive disorders, gestational diabetes, and delayed prenatal care. These poor maternal outcomes are shaped by challenges such as geographic isolation and limited resources. Community Health Worker (CHW)-led interventions, combined with mobile health (mHealth) technology, hold promise for improving early healthcare 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 processes, and engagement patterns, laying the foundation for a future NIH R01 evaluating SAFE’s effectiveness in reducing AIAN maternal health morbidity. The specific aims of this study are: 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. This study will result in a co-created, community-tailored CHW intervention supported by remote monitoring for AIAN pregnant women. It will also identify effective recruitment and referral strategies, optimize engagement approaches, and evaluate site-specific implementation impediments and facilitators to inform optimal design of a future R01 efficacy trial of SAFE. Project Number: 5P20GM139733-03 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of General Medical Sciences (NIGMS) | Principal Investigator: Christina Pacheco | Institution: UNIVERSITY OF KANSAS MEDICAL CENTER, KANSAS CITY, KS | Award Amount: $232,500 | Activity Code: P20 | Study Section: ZGM1-RCB-3(C1) View on NIH RePORTER: https://reporter.nih.gov/project-details/11498848