Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs

Figure 2

STAR MAMA health-IT intervention linkage model: using the health coach as a bridge between the community and hospital infrastructure for postpartum GDM women. (1) A woman is enrolled into the STAR MAMA study based on her eligibility. See Table 1 for baseline demographics. Eligible WIC participants were referred to the STAR MAMA study by their respective coordinators. (2) Enrolled participants select call times to receive proactive calls or call in toll-free from the automated telemedicine system. Each week participants receive a rotating set of prevention-focused queries, narratives, and texts (e.g., on diet, exercise, breastfeeding, and baby care). If a participant enters a value predefined as “out of range,” participants also hear recorded first person supportive narratives related to their “out-of-range” reply encouraging behavior change as well as narratives offering shorter tips. (3) Each participant is matched with a health coach, a trained nonprofessional individual recruited for this study. The health coach is trained on health coaching protocol and diabetes prevention (Center for Excellence in Primary Care). The coach receives automatically downloaded daily reports from the ATSM calls and participant responses. Depending on the participant’s needs, the health coach calls back to provide participant with emotional support and engage participant in goal setting/action and provides information about community resources. (4) ((4a) and (4b)) The health coach can connect the patient with community programs, food banks, farmers markets, WIC counselors, mental health support groups, and so forth. Additionally, the coach may send a notification to a patient’s clinic and/or clinician if deemed urgent, based on predetermined protocols.