The Preconception Stress and Resiliency Pathways Model: A Multi-Level Framework on Maternal, Paternal, and Child Health Disparities Derived by Community-Based Participatory Research

Abstract

Emerging evidence supports the theoretical and clinical importance of the preconception period in influencing pregnancy outcomes and child health. Collectively, this evidence affirms the need for a novel, integrative theoretical framework to design future investigations, integrate new findings, and identify promising, evidence-informed interventions to improve intergenerational health and reduce disparities. This article presents a transdisciplinary framework developed by the NIH Community Child Health Network (CCHN) through community-based participatory research processes. CCHN developed a Preconception Stress and Resiliency Pathways (PSRP) model by building local and multi-site community-academic participatory partnerships that established guidelines for research planning and decision-making; reviewed relevant findings diverse disciplinary and community perspectives; and identified the major themes of stress and resilience within the context of families and communities. The PSRP model focuses on inter-relating the multiple, complex, and dynamic biosocial influences theoretically linked to family health disparities. The PSRP model borrowed from and then added original constructs relating to developmental origins of lifelong health, epigenetics, and neighborhood and community influences on pregnancy outcome and family functioning (cf. MCHJ 2014). Novel elements include centrality of the preconception/inter-conception period, role of fathers and the parental relationship, maternal allostatic load (a composite biomarker index of cumulative wear-and-tear of stress), resilience resources of parents, and local neighborhood and community level influences (e.g., employment, housing, education, health care, and stability of basic necessities). CCHN's integrative framework embraces new ways of thinking about how to improve outcomes for future generations, by starting before conception, by including all family members, and by engaging the community vigorously at multiple levels to promote resiliency, reduce chronic and acute stressors, and expand individualized health care that integrates promotive and prevention strategies. If widely adopted, the PSRP model may help realize the goal of sustaining engagement of communities, health and social services providers, and scientists to overcome the siloes, inefficiencies, and lack of innovation in efforts to reduce family health disparities. Model limitations include tremendous breadth and difficulty measuring all elements with precision and sensitivity.

Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods

“…Over the course of 2 years of planning, CCHN developed an integrative conceptual model that identified many pathways by which stress may contribute to maternal and child health outcomes (see Ramey et al, 2013). The network was informed in this work by a paradigm shift in health disparities research (Marmot, 2000; Smedley & Syme, 2000) involving an emphasis on multilevel and divergent influences on health.…”

Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics

“…More sophisticated and integrative theoretical frameworks variously integrate critical developmental periods, evolutionary-developmental theory, epigenetics, family and community ecology, maternal AL, resilience resources, and local neighborhood and community level influences (115,116). These comprehensive approaches are also applicable to lowand middle-income countries (117).…”

Cortisol covariation within parents of young children: Moderation by relationship aggression

“…All study procedures followed Declaration of Helsinki procedures and were carried out with the adequate understanding and written consent of the subjects. Recruitment, eligibility, and demographic characteristics for the larger five-site CCHN study are described in other papers (Ramey, et al, 2014; Dunkel Schetter et al, 2013). To summarize, biological mothers were recruited at the birth of their first, second, or third child (referred to as the “index child” for study purposes) and followed at multiple time-points over the first two years postpartum.…”