Systemic Health Intervention Design through Participatory Modeling: Low-dose Aspirin for Women at Risk of Preeclampsia

Author(s): Yin Jien Lee, Leslie Kowalewski, Jeff Gould, Lindsay du Plessis, Bryan Oshiro, Melody Moua, David K Stevenson, Gary L Darmstadt

Preeclampsia (PE) and eclampsia accounted for 7% of maternal mortality in the United States (2016 – 2018). In California, in-hospital diagnosed PE rates rose from 4.6% to 8.1% (2017-2023), with severe cases increasing from 2% to 4% and mild-to-moderate cases from 1% to 2.7%. Clinical guidelines recommend a daily low-dose aspirin (LDA) regimen of 81 mg starting at 12 weeks’ gestation for at-risk women. However, uptake rates remain suboptimal (47% to 79%). Informed by the literature, women with lived experiences for complicated pregnancies, and healthcare stakeholders in Riverside, California, we developed a participatory system dynamics (SD) simulation model, incorporating focus groups, group model building (GMB), and simulation modeling to identify interventions that could increase LDA uptake. The simulation tested 26 scenarios. Six key drivers of increased LDA uptake were identified: (1) frequency of women’s interpersonal contacts, (2) dissemination of information by authoritative organizations online, (3) time required for nurse training on LDA protocols, (4) timing of enrollment in home visiting programs, (5) capacity of trained home visitors, and (6) awareness of home visiting programs among pregnant women. Optimizing these variables increases projected LDA uptake by 63% over 120 months. Our findings demonstrate how participatory modeling can identify actionable system-level interventions to improve guideline adherence and maternal health.