Assigment .apa seven . all instructions attached.

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Strengths (What Was Met)

You clearly identified maternal mortality and prenatal disparities among Black women as a critical public health issue and supported your introduction with strong national, global, and Florida-specific data, which effectively establishes the urgency and relevance of the problem.

You defined a specific and highly appropriate vulnerable population (Black pregnant women in Miami-Dade County) and provided a strong, evidence-based discussion of risk factors, including structural racism, access barriers, chronic conditions, and delayed prenatal care.

Your proposed outcomes are present and measurable in concept (increased first-trimester care initiation and improved adherence to prenatal visits), demonstrating alignment with assignment expectations.

The literature review includes scholarly sources and discusses evidence-based interventions such as care coordination and doula support. You also identified strengths and limitations of each study.

You demonstrated good synthesis of the literature, recognizing the importance of culturally competent, patient-centered, and multicomponent interventions.

The theoretical framework (Pender’s Health Promotion Model) is appropriate and well explained, with clear connection to behavior change, patient empowerment, and engagement in prenatal care.

References are credible, scholarly, and generally aligned with in-text citations, meeting graduate-level expectations.

Not Met / Requires Full Development for Week 8 Final Submission

The health promotion program is not fully operationalized:

While the focus (early prenatal care and education) is clear, the proposal lacks:

Specific intervention activities (what exactly will be done)

Clear implementation plan (who delivers the program, where, how often, format, duration)

Structured program design

For Week 8, the intervention must be fully detailed and actionable.

The measurable outcomes are not fully developed:

Outcomes are described generally (increase in early prenatal care and adherence)

There are no specific percentage targets or benchmarks

No clear explanation of how outcomes will be measured (tools, timing, baseline vs. follow-up)

These must be rewritten in full SMART format.

The literature review does not fully meet assignment structure requirements:

The assignment requires:

Two clearly separated article summaries (one paragraph each)

Followed by a 2–3 paragraph evaluation section

While content is present, the structure is not clearly separated and needs reorganization

The evaluation of literature is underdeveloped:

Limited comparison across studies

Minimal identification of gaps in the literature

Weak linkage between evidence and your proposed intervention design

This section requires stronger graduate-level analysis and synthesis

The vulnerable population section, while strong, could benefit from additional citation support in some areas (e.g., transportation barriers, insurance access, stress pathways).

The theoretical framework is not fully operationalized:

While Pender’s model is explained well, there is limited explicit linkage between specific constructs and intervention components

For Week 8, clearly map program activities to model constructs

There are reference and accuracy concerns:

Typographical error in citation: “Hoyert, 225” should be corrected to 2025 ❗

One key source used in-text (Njoku et al., 2023) is missing from the reference list ❗

This indicates a reference mismatch that must be corrected

There are APA and scholarly writing issues:

Minor grammatical inconsistencies

Sentence clarity and flow need improvement

Ensure strict adherence to APA 7 formatting

Proposalpart1copy.docx

2

Maternal Mortality and Prenatal Health Disparities in Black Women

The issue of maternal mortality and prenatal health disparities is a crucial public health problem in the US and continues to disproportionately affect people who identify as black: American women are chronically more likely than their white counterparts to have complications from pregnancy, birth and postpartum conditions. National data indicate that the rate of U.S. maternal mortality was 18.6 deaths per 100,000 live births in 2023 overall but for non-Hispanic Black women, it was 50.3 per 100,000 live births, which stood significantly higher compared to the rates among White (14.5) and Hispanic women (12.4), respectively (Hoyert, 2025). World over, maternal mortality remains unacceptably high; approximately 260000 women of reproductive age will die in 2023 from preventable causes related to pregnancy (World Health Organization [WHO], 2025), highlighting the critical need for early and equitable access to high-quality prenatal services. There are still inter-generational inequalities reflected in the maternal and infant health indicators, with Florida reporting a 24.5 death per 100,000 births maternal mortality rate, and only 65.9% adequate prenatal care for the state compared to national standards (March of Dimes, 2025). Thus, the identified need for this health promotion program is to reduce the incidence of late and inadequate prenatal care among Black pregnant women in Miami-Dade County through culturally tailored education and early linkage to prenatal services and resource navigation. A concrete and attainable outcome will be to increase the percentage of participants that initiate prenatal care in the first trimester, as well as improve adherence to scheduled prenatal visits within six months post-implementation (Hoyert, 225; March of Dimes, 2025).

Vulnerable Population

Black pregnant women constitute a high-risk population in Miami-Dade County because the accumulation of clinical, social and structural determinants are associated with adverse maternal outcomes. A key contributor is structural racism, which shapes both the environments in which women live and their quality of care; their access to transportation and insurance; and exposure to chronic stress over a lifetime. A systematic review prepared by Hailu et al. (2022) consistently associates structural racism with poor maternal health outcomes, including preterm birth, severe maternal morbidity and mortality. In addition, Njoku et al. (2023) noted, implicit bias, fragmented care, limited access to timely prenatal services and social determinants like poverty, housing instability and food insecurity all play roles in the Black maternal health crisis in this country.

Second, lack of or delayed prenatal care prevents early screening and management of conditions that impact pregnancy (hypertension, diabetes, infection, obstetric complications). According to WHO (2025), most maternal deaths are preventable with the availability of timely skilled care during pre-conception, and during and after delivery. In a state like Florida, where prenatal care metrics are below trajectory and enjoy considerable racial inequities (March of Dimes, 2025), this is particularly critical. Another risk factor is the disproportionate burden of chronic conditions and pregnancy-related hypertension, which also increases risk for Black women. Today, Florida is facing a national state of maternal health crisis, with high rates of maternal mortality and severe morbidity due to hypertension in pregnancy and other conditions that threaten adverse birth outcomes (March of Dimes, 2025). This provides a rationale for considering these women, as they experience additive risk at the individual, community and system levels, to be an appropriate and high priority population towards which a targeted health promotion program could be directed.

Review of Literature on Evidence-Based Interventions

Howell et al. (2022) conducted a community-based intervention study focused on the effect of improved prenatal care coordination initiatives on maternal morbidity in Black populations. The intervention consisted of patient navigation, culturally tailored education, and integration of social support service. The study showed that women randomized to the intervention reported significant increase in early initiation of prenatal care and decrease in severe maternal morbidity. A strength of this study is that it uses a large, diverse sample, and real-world clinical settings, which increases external validity. Furthermore, the intervention was multisectoral as it addressed both clinical and social determinants of health. However, a limitation includes potential variability in implementation across sites that may influence consistency of outcomes (Howell et al., 2022).

An additional study relevant to this analysis by Kozhimannil et al. (2020) examined whether doula-supported care improves maternal outcomes for underserved populations. From its review, continuous labor support from doulas was linked to lower cesarean rates as well as improved patient satisfaction and perinatal outcomes. A significant strength of this study is the focus on patient-centered care and culturally sensitive support which directly addresses disparities experienced by Black women. Limitations of doula use include issues around scalability and reimbursement, which could affect implementation if doula programs were to scale up (Kozhimannil et al., 2020).

In summary, both interventions were highly valued among the populations they served, and both promote culturally competent, patient-centered care with an emphasis on improving outcomes for all mothers. Care coordination programs have demonstrated effectiveness in overcoming systemic barriers such as delays or fragmentation of access to care, while doula support provides emotional and physical support before and during childbirth. These interventions fill inter-related gaps and address the needs of patients (Howell et al., 2022; Kozhimannil et al., 2020).

Though these studies have several strengths, literature also outlines limitations. Numerous studies over samples of specific populations or geographic settings which are limitation to growing generalizability. Moreover, financial and policy barriers like limited insurance coverage for doula services inhibit sustainability. These have yet to be integrated into larger scalable, policy-supported models for ensuring sustained impact and equity in the delivery of maternal healthcare that can reach broader sectors of society.

Theoretical Framework

For this health promotion proposal, the theoretical framework that fits best is Pender’s Health Promotion Model. This type of model highlights the impact that personal experiences, behavior-specific cognitions and environmental elements have on health behaviors. Definition of patient empowerment is more relevant to maternal health as it emphasizes empowering individuals to make an effective contribution towards improving his/her good health. The model identifies perceived barriers, perceived benefits, and self-efficacy as key predictors of behavior change that have also been found to be essential in early and consistent use of prenatal care (Rojas-Torres et al., 2022).

Pender’s Health Promotion Model is particularly applicable to elucidate disparities among Black women as it incorporates social and interpersonal influences such as the involvement of family, relationships with healthcare providers, and community resources. Such factors are key for overcoming mistrust, improving engagement with health services, and tackling social determinants of health. The model incorporates culturally responsive education and support systems which include evidence-based interventions detailed in literature such as care coordination and doula support. Furthermore, this framework supports the development of measurable outcomes by linking behavioral changes such as early prenatal care attendance to improved health outcomes. It allows healthcare providers to design interventions that are individualized and community-focused, increasing the likelihood of sustained behavioral change. Therefore, Pender’s Health Promotion Model provides a comprehensive and practical foundation for guiding this health promotion program aimed at reducing maternal health disparities among Black women in Miami-Dade County (Shahroodi et al., 2022).

References

Hailu, E. M., Maddali, S. R., Snowden, J. M., Carmichael, S. L., & Afulani, P. A. (2022). Structural racism and adverse maternal health outcomes: A systematic review. Health & Place, 78, 102923. https://doi.org/10.1016/j.healthplace.2022.102923

Hoyert, D. L. (2025). Maternal Mortality Rates in the United States, 2023. In NCHS Health E Stats. National Center for Health Statistics (US). https://doi.org/10.15620/cdc/174577

March of Dimes. (2025). 2025 March of Dimes report card for Florida. https://www.marchofdimes.org/peristats/reports/florida/report-card

Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P., Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025). Effectiveness of Nola Pender's Health Promotion Model: A Comprehensive Approach for Enhancing Healthy Behaviors and Quality of Life in Adults. International journal of environmental research and public health, 22(10), 1506. https://doi.org/10.3390/ijerph22101506

Shahroodi, M. V., Sany, S. B. T., Khaboshan, Z. H., Orooji, A., Esmaeily, H., Ferns, G., & Tajfard, M. (2022). Psychosocial Determinants of Changes in Dietary Behaviors Among Iranian Women: An Application of the Pender's Health Promotion Model. Community health equity research & policy, 42(2), 209–218. https://doi.org/10.1177/0272684X20976825

World Health Organization. (2024). Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality