Smart Start of Transylvania County, a nonprofit organization that is part of the North Carolina Partnership for Children, aims to propel young children and their families towards health and success. Understanding that early childhood development begins before birth, in addition to supporting families of children aged 0-5, they offer maternal health services to assist expectant mothers throughout pregnancy. They believe that all expecting parents, irrespective of their income level, racial status, or geographic location, deserve access to fundamental healthcare services needed to properly care for their baby during the pre and postnatal development stages. Striving towards a more equitable landscape in Maternal Child Health (MCH), the socioeconomic factors that affect a mother’s ability to have a healthy pregnancy and birth must be examined. 

Currently, the number of preterm births in Western North Carolina exceeds the number of preterm births statewide at both a regional and county level. Additionally, infant mortality rates in North Carolina are among the highest in the nation, at a rate of 6.77 infant deaths per 1,000 live births. This rate is even higher in certain areas, particularly stricken by poverty, racial inequities, and/or geographical challenges to healthcare access. Addressing and improving this preterm birth rate as well as the overall infant mortality rate is of utmost importance in order to ensure a healthy future for all children and families in our communities. 

In order to increase health support services available to mothers pre-pregnancy through postpartum, factors most drastically affect maternal health across WNC, as well as which geographic areas in the region are most critically suffering from a lack of proper healthcare, must be understood. Over the next year and a half, SSTC, East Tennessee State University, and Western Carolina University will work collaboratively with funding from Dogwood Health Trust. The collaboration aims to investigate disparities in maternal and children's health in Western North Carolina and develop a Geographic Information System Dashboard. This tool will map the variations and trends in socio-economic status, healthcare access, broadband connectivity, transportation, and MCH outcomes on both county and census tract levels. Funding from Dogwood Health Trust, paired with the invaluable knowledge of this collaboration, will allow a unique opportunity to accelerate research to identify inequities in health care in WNC, in order to address them in a timely manner. 

GIS has been shown to help prevent maternal and newborn mortalities by identifying their root causes. ETSU’s Center for Applied Research and Evaluation in Women’s Health and ETSU’s Center for Rural Health Research will work together to provide the necessary scientific background needed to create a comprehensive GIS dashboard system for our region. The project leads from these two departments come from diversified backgrounds, specializing in a range of modalities, including mixed-methods research methodology, complex statistical analysis, rural health, psychology, and GIS technology. The GIS tool will be co-developed via Community Engagement Studios, which are a method for community-based research that are designed to engage with key partners. 

SSTC is particularly committed to community-based work. Their efforts to improve the early childhood landscape are strengthened through collaboration with community partners who help us reach and understand local families and their specific needs. In order to inform this research and fully understand its impact, SSTC will work with WCU within this initiative to conduct community based research that engages directly with those most affected by inequities in MCH. 

WCU’s project lead serves as the director of the Birth-Kindergarten program, and holds a robust background in behavioral sciences, psychology, and education. Pairing SSTC’s knowledge of and connections to community-based organizations in WNC with WCU’s research capabilities, we will work alongside community partners to form focus groups and distribute caregiver surveys to expectant mothers and families of children age 0-3, to best understand how social determinants impact individuals’ health and wellbeing, as well as identify ways that the pandemic may have created or exasperated issues related to healthcare access. 

A survey is being developed to capture information from a broader group of participants across Western North Carolina about various social and environmental factors, such as access to transportation, internet services, and health care. Focus groups will be centered around sociocultural factors that affect access to healthcare, such as families’ access to the internet and transportation as well as the distance between residences and health care facilities. By studying these often overlooked social determinants and identifying their overall impact on the health of families and children, collaborators will be able to identify which areas of the region women and children are most underserved due to lack of access to healthcare or low income. 

The quantitative survey, and the qualitative data collected within the focus groups by WCU and SSTC will be paired with the quantitative data collected by ETSU, with the GIS dashboard mapping these findings alongside demographics like race, gender, and income level of populations in WNC. The results will be reported to health leaders, and the areas identified as most underserved will be of top priority for healthcare intervention services. Additionally, they intend to use data collected from this research to influence public funding and to inform the planning and implementation of a region-wide project designed to improve MCH through various support services. Collected research will also aid in establishing consistent language surrounding MCH so that we are able to advocate for MCH support across the region most effectively. 

The varied strengths and backgrounds of these three organizations combine knowledge and experience in ways that will hopefully prove to be innovative, illuminating, and impactful. It is because of Dogwood Health Trust’s commitment to reducing health disparities that the collaborators are able to come together in this initiative to work creatively to eliminate barriers and positively influence the health of women and children. By creating a more equal playing field in the world of healthcare, they hope to foster a stronger sense of community and support across the region so that all children get a strong start in life and all families feel valued and cared for. 

Source: Smart Start of Transylvania County