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Date Available

4-17-2026

Year of Publication

2026

Document Type

Graduate Capstone Project

Degree Name

Master of Public Health (M.P.H.)

College

Public Health

Department/School/Program

Public Health

Faculty

Dr. Paula Arnett

Committee Member

Dr. Sarah Vos

Faculty

Dr. Elizabeth Riley

Abstract

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based education, peer support, and system-level care coordination. Its goal is to enhance early prenatal engagement, improve continuity of care, and increase access to risk-appropriate services.

Key partnerships with public health agencies, healthcare providers, and community organizations support implementation and sustainability. Expected outcomes include increased prenatal care utilization, improved maternal health behaviors, and reductions in preterm birth and low birth weight. A mixed-methods evaluation using a pre-post design will assess program effectiveness and guide continuous improvement. By addressing both healthcare access and social determinants, Stronger Starts offers a scalable model for improving maternal and infant health in rural communities.

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