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

Table 2

Health coaching case studies: San Francisco and Sonoma WIC participants.

Site	Case studies: summaries of coaching calls with women enrolled in the HIT and coaching arm	Health coaching actions	Examples of range of efforts undertaken to address complex emotional, health literacy, and instrumental needs
San Francisco WIC	() Ms. C., a 33-year-old, Latina woman with a recent history of diet-controlled GDM received her first health coach call during week 1 of the STAR MAMA study, when she was 8 weeks postpartum. She is a homemaker and not married, but living with a partner in a marriage-like relationship. Ms. C. delivered her baby at 39 weeks. While she understood key steps and requirements for baby care, she reported feeling overwhelmed due to the stress of caring for her three other children as well. In addition to reported practical support and feeling like she had someone to listen to her; the health coach provided support and identified that she was not suffering from depression. In the third week, Ms. C. reported mixed-feeding for her baby with breast milk and pumped milk, a shift from her exclusive breastfeeding in the past two weeks. Her health coach encouraged her to exclusively breastfeed whenever possible and reviewed the importance of breast milk for a growing infant. With this and other supports, Ms. C., who reported high intention to breastfeed prior to pregnancy, was able to eventually continue without formula for the first 6 months. During the fifth week, Ms. C. reported binging on unhealthy snacks: soda, sweets, and foods from the local taqueria. After querying about her symptoms, her health coach was concerned that she displayed signs of elevated blood sugar. She discussed the dangers of a high fat and high sugar diet and encouraged her to replace soda with water. Together, they set goals and her health coach followed up weekly to assess her implementation of her action plan. Additionally, her coach helped Ms. C. make an appointment with primary care provider to get her blood sugar rechecked	(i) Supportive counseling and provision of postpartum stress management strategies; (ii) Encouragement of sustained breast feeding for first 6 months and instruction for safe bottle-feeding; (iii) Assessment of participant-specific barriers to reducing a high sugar and high fat diet; develop a set of resources and tools to share with participant for managing postpartum eating habits for self and family; (iv) Assistance with reconnecting with the primary care setting (community clinic or hospital) to follow-up on her health status	(i) Participant was uncertain about the meaning of her screening test result and what to do next; (ii) Participant benefited from tailored breast feeding support within the context of the stresses encountered with multiple children’s needs to address besides baby
San Francisco WIC	(2) Ms. F., a 21-year-old Latina woman with a recent history of diet-controlled GDM during her pregnancy. During pregnancy she worked part-time (<20 hours) in food delivery and was not married but living with only her partner and pregnant with her first child. She received her first health coaching call during her week 1 of enrollment in STAR MAMA, 8 weeks postpartum, when she reported feeling like she could not do all the things she needed for her baby. She was occupied with her baby’s belly button, which she thought looked a bit abnormal, and was denied a follow-up appointment since the baby’s MediCal was inactive. Her health coach informed Ms. F. about the different MediCal managed care plans and advised her on how to communicate with MediCal and switch her baby to a good plan. During pregnancy, Ms. F. reported high intention to breastfeed and mainly breastfed her baby, supplemented sometimes with formula. Her health coach reinforced the importance of exclusive breastfeeding and offered a breast pump from WIC for Ms. F. to borrow. In the following weeks, Ms. F. contacted MediCal and was able to get her case reviewed. Though she wanted to start her baby on solid foods, her health coach suggested waiting until the baby was approaching 5-6 months and she reviewed the risks of starting solid foods preemptively. Ms. F. was motivated to follow these recommendations and take full precaution when feeding her baby. She also cleared her doubts about babies burping and fat consumption with her health coach	(i) Provide support and knowledge on postpartum baby care and time management; (ii) Guide participant with activation and follow-up of baby’s MediCal plan; (iii) Review and instruct participant on proper complementary feeding practices (timing, what to start, frequency, assessing hunger cues); (iv) Answer miscellaneous questions and provide longitudinal support on various doubts (belly button, baby burping, etc.) that participant may have as a new mother	(i) Participant needed support and guidance on how to renew her baby’s MediCal plan to facilitate continued care; (ii) Participant received extra support and resources from the health coach (i.e., breast pump from WIC) to enable exclusive breastfeeding and instructions on how and when to start complementary feeding
Sonoma County WIC	() Ms. H., a 33-year-old Latina woman was enrolled in the study at 7 weeks postpartum and received health coaching calls during her fifth week in the study. She is a homemaker and married and delivered her fourth child at full-term. Her health coach gave her ideas about encouraging children to eat healthier foods, that is, fruits and vegetables, since she had younger children in her family (two children <5 years old, in addition to the new baby) who were fussy eaters. She was not too keen on exercising, but her health coach applauded her for trying at least once a week and encouraged her to exercise more frequently which was a great accomplishment; though at home Ms. H. felt that she had someone to listen to and comfort her, she did not feel that she had support with practical help. During the 15th week, Ms. H. struggled with cutting back on fatty foods and sugary drinks, like sodas. Her health coach worked with her to make a plan and incorporate quick tips to address these issues, such as draining fat during cooking and making homemade agua frescas. Her health coach also provided her with many local, community-based food resources. Ms. H. was left feeling supported, motivated, and confident in her ability to make changes (see Figure 3)	(i) Provide tips on managing other children, especially encouraging healthy habits for fussy eaters; (ii) Improve knowledge about exercise benefits and suggest recommendations and strategies to integrate physical activity into participant’s daily schedule; (iii) Discuss techniques to substitute high fat/sugar foods with healthier alternatives	(i) Participant needed information and support on how to control the diets of fussy eaters; (ii) Participant needed reinforcement on exercise and healthier substitutes; (iii) Participant received relevant information on local food banks and community resources to improve self-management and care
Sonoma County WIC	() Ms. G. is a 24-year-old Latina woman. She is a homemaker, living with a partner in a large household of 12 individuals. Though she reports feeling like once she had the baby she was able to get help with cooking and other tasks, she did not feel supported emotionally. Her baby was born full-term in a vaginal birth. She was enrolled into the study and started receiving health coaching calls at 7 weeks postpartum. Due to poor latching, Ms. G. breastfed for just 3 weeks and started with formula milk for her baby. Her health coach instructed her on safe bottle-feeding practices and reviewed hunger cues to prevent overfeeding and recognize signs of fullness. Around the sixth week, Ms. G. reported feeling overwhelmed, tired, and depressed. Her health coach discussed the commonness of baby blues after delivery and relevant symptoms and encouraged Ms. G. to speak with her primary care provider about this in her upcoming appointment. In follow-up calls, Ms. G. was able to appropriately recognize hunger cues and her mood improved after taking her multivitamins and eating properly	(i) Review safe bottle-feeding practices and support on adapting to baby hunger cues; (ii) Provide emotional support and reassurance about baby blues; (iii) Facilitate connection between participant and primary care provider postpartum to acknowledge issues of postpartum depression	(i) Participant received preliminary postpartum depression screening, so she could be appropriately directed to a primary care provider; (ii) Participant was uncertain about baby hunger cues and proper bottle-feeding practices