Outcome evaluation of an Applied Multiple Determinants Model to improve birth outcomes

Results of an outcome evaluation of an Applied Multiple Determinants Model have important implications for improving birth outcomes and reducing related disparities. The project was initiated in 1999 in an area where a significant proportion of at-risk black women and families in Jacksonville reside. Black infant mortality has been high in the Jacksonville area, with annul rates hitting 17/1000. The high-risk area of Jacksonville where the project is located accounts for 40% of the black infant mortality in the city (about 38% of Black births). This area has considerable environmental, social and economic deficits that impact maternal and infant health. The primary approach of the Magnolia Project is a case management approach that links social and behavioral counseling, education and support to culturally sensitive and community based clinical services for high risk women before they become pregnant (again). A research design to assess impact was developed including a matched comparison group from a similar area and a logic model that linked the intervention to distal outcomes through intermediate outcomes. The different levels of outcome and process required very different designs, and data collection and analysis procedures. The findings from the study are promising with statistically significant reductions in low-birth-weight births and STDs among the participating women. Highly meaningful reductions in infant mortality (over 40/1000) were observed, but these reductions were not statistically significant due to the small number of live births. The results provide important insights for both program development and evaluation research design.