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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Mobile Medical Clinics

Approach. Promote the use of mobile health clinics to provide postpartum preventive care in communities experiencing health disparities and limited access to healthcare services

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Overview. Mobile health clinics [MHCs] have proven to be successful in reaching populations experiencing health disparities—delivering curbside services in communities with limited access to healthcare and adapting services based on the changing needs of the population served.[1] During the COVID-19 pandemic, MHCs were able to provide preventive care services to postpartum women and their newborns. Satisfaction rates were high among surveyed participants. The healthcare providers were successful in screening patients and diagnosing conditions such as hypertension and postpartum depression. MHC providers can also provide Family Planning consultations and referrals to primary care practitioners and behavioral health specialists.[2,3]. Furthermore, evidence suggests that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in communities experiencing health disparities and limited access to healthcare. [1] Overall, MHCs appear to be an effective way to reach postpartum women who are unlikely to obtain timely preventive care.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings). This strategy is also supported as "Mobile Reproductive Health Clinics" in the What Works for Health database.

Source. Peer-Reviewed Literature and What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of postpartum individuals who access and utilize postpartum preventive care services through MHCs. (Measures the engagement and utilization of the strategy by the focus population)
  • Number of healthcare providers, staff, and community health workers trained and deployed to deliver postpartum preventive care services through MHCs. (Assesses the workforce capacity and readiness for the strategy)

OUTCOME MEASURES:

  • Number of postpartum conditions, complications, and risk factors identified and addressed through MHC-based postpartum preventive care services. (Measures the early detection and intervention impact of the strategy)
  • Number of postpartum individuals who receive timely referrals and linkages to primary care, behavioral health, and social services through MHCs. (Measures the care coordination and integration outcomes of the strategy)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of MHCs that provide comprehensive, evidence-based postpartum preventive care services, including screening, education, counseling, and referrals. (Measures the quality and fidelity of the strategy)
  • Percent of postpartum individuals served by MHCs who receive culturally and linguistically appropriate care, resources, and support. (Measures the equity and patient-centeredness of the strategy)

OUTCOME MEASURES:

  • Percent of postpartum individuals who receive recommended preventive care services, such as immunizations, contraception, and mental health screening, through MHCs. (Measures the adherence to postpartum preventive care guidelines)
  • Percent reduction in disparities in postpartum preventive care access and utilization among underserved communities reached by MHCs. (Assesses the health equity impact of the strategy)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships and collaborations established between MHCs, healthcare systems, payers, and community organizations to support the sustainability and integration of postpartum preventive care services. (Measures the multi-sector engagement and alignment approach of the strategy)
  • Number of policies, funding mechanisms, and reimbursement models developed to support the long-term viability and scalability of MHC-based postpartum preventive care services. (Measures the enabling environment and systems change efforts for the strategy)

OUTCOME MEASURES:

  • Number of underserved communities that achieve significant and sustained improvements in postpartum preventive care access, utilization, and outcomes through the implementation of MHCs. (Measures the community-level impact and spread of the strategy)
  • Number of healthcare systems, payers, and policymakers that recognize and invest in MHCs as a key strategy for advancing postpartum health equity and reducing maternal health disparities. (Measures the field-building and agenda-setting influence of the strategy)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of MHC planning, implementation, and evaluation process that actively engage and support postpartum individuals and community members as co-designers and decision-makers. (Measures the participatory and community-driven approach of the strategy)
  • Percent of MHC funding and resources allocated to address social determinants of health and upstream drivers of postpartum health inequities, such as economic instability, transportation barriers, and food insecurity. (Measures the health equity and social justice focus of the strategy)

OUTCOME MEASURES:

  • Percent reduction in structural and systemic barriers to postpartum preventive care access and utilization, such as discrimination and geographic isolation, through the tailored and responsive deployment of MHCs in communities facing economic or social barriers. (Measures the social determinants and health equity outcomes of the strategy)
  • Percent of overall community health and well-being indicators, such as social cohesion, resilience, and support, that improve as a result of the trust-building, relationship-centered, and community-embedded approach of MHCs in delivering postpartum preventive care. (Assesses the community-level and upstream impact of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health. 2017 Oct 5;16(1):178. doi: 10.1186/s12939-017-0671-2. PMID: 28982362; PMCID: PMC5629787. During the COVID-19 pandemic, mobile clinics reached out to marginalized populations, providing postpartum care and well-infant checkups to marginalized populations.
[2]Rosenberg, J., Sude, L., Budge, M., León-Martínez, D., Fenick, A., Altice, F. L., & Sharifi, M. (2022). Rapid Deployment of a Mobile Medical Clinic During the COVID-19 Pandemic: Assessment of Dyadic Maternal-Child Care. Maternal and child health journal, 26(9), 1762–1778. https://doi.org/10.1007/s10995-022-03483-6.
[3] McGuinness, C., Mottl-Santiago, J., Nass, M., Siegel, L., Onyekwu, O. C., Cruikshank, A., Forman, R., & Weir, G. (2022). Dyadic Care Mobile Units: A Collaborative Midwifery and Pediatric Response to the COVID-19 Pandemic. Journal of midwifery & women's health, 67(6), 714–719. https://doi.org/10.1111/jmwh.13432

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.