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  Vol. 1, Issue 1 

ENGAGE!  2019 Vol. 1 No. 1 https://doi.org/10.18060/22727 

Copyright © 2019 Author(s). 

 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. 

GRASSROOTS MATERNAL CHILD HEALTH LEADERSHIP CURRICULUM 

LINDSEY SKINNER, DEBORAH STIFFLER, NANCY SWIGONSKI, KARA CASAVAN, ASHLEY IRBY, 
LARONA DIXON, AND JACK TURMAN JR.  

ABSTRACT 

In the United States, Indiana ranks 43rd for its infant 

mortality rate. Twenty-nine of the 988 Indiana ZIP 

codes account for 27% of infant deaths. There is a need 

to train and mentor community members in these high 

risk ZIP codes to lead local maternal and child health 

(MCH) efforts that address the priorities of community 

members related to poor birth outcomes. A 

comprehensive grassroots MCH leadership curriculum 

is needed for this training process. We developed a 

curriculum designed to train community members in 

Indiana’s high-risk ZIP codes to be grassroots maternal 

child health leaders (GMCHL). A team of public health 

faculty, clinicians, social service practitioners and 

community leaders developed the initial curriculum. 

Community feedback sessions that included grassroots 

community members, local clinicians and social service 

providers and non-profit leaders were conducted to get 

feedback on curriculum content. This feedback was 

incorporated to create the resulting grassroots MCH 

leadership training program. This curriculum provides 

a framework that can be used and adjusted to meet the 

needs of diverse communities across our nation to 

train residents to emerge as local MCH leaders that 

advocate for healthy pregnancies for all. 

Keywords: social determinants of health, infant 

mortality, community development, policy advocacy, 

women’s empowerment  

INTRODUCTION 

The measurement of infant mortality (IM) 

(death before an infant’s first birthday) is used 

throughout the world as a key indicator of a nation’s 

health and well-being (CDC, 2018). Among the United 

States, Indiana ranks 43rd for its infant mortality rate 

(CDC, 2018). Twenty-nine of the 988 Indiana ZIP codes 

account for over one quarter (27%) of infant deaths 

(Indiana State Department of Health [ISDH], 2017). 

Current approaches to address this problem include 

home visiting services, healthcare policy changes, 

increasing awareness among healthcare providers and 

interventions targeting individual health behaviors. 

Community-based grassroots efforts to raise the 

awareness and action of citizenry to address this vital 

public health problem and advocate with a 

community-centered voice is lacking. We are 

addressing this need by developing a curriculum, 

grounded in the Social Ecological Model (SEM) of 

Health Promotion (Bronfenbrenner, 1994), to train 

grassroots maternal and child health leaders (GMCHL) 

to lead community-based efforts to reduce infant 

mortality. 

https://doi.org/10.18060/22727
http://creativecommons.org/licenses/by-nc/4.0/


ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

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Addressing societal factors by equipping 

GMCHL to be health and social change agents is 

crucial to creating and sustaining a culture that 

promotes neighborhood health. Previous studies 

demonstrate that fostering community leaders for 

community-based health promotion efforts resulted in 

program sustainability, incorporation of health 

promotion elements into non-health sector 

community institutions and mediated the creation of 

multisector teams in the community to address health 

problems (Goodman & Steckler, 1987/88; Orlandi, 

1986; Shediac-Rizkallah & Bone, 1998. Our approach 

builds on the previous work of others by incorporating 

the lifecourse theory (Lu & Halfton, 2003), a place- and 

community-based approach (Gabbe et al., 2017; Pies, 

Barr, Strouse, & Kotelchuck,, 2016) and bringing the 

community in as its own specific discipline (Reynolds 

et al., 2015; Smith, Tiwari, & Lommerse, 2014). This 

manuscript presents the process of developing and 

testing this curriculum for training GMCHL. A detailed 

MCH leadership training curriculum for grassroots 

community leaders is missing from the literature. The 

curriculum we developed can be applied to community 

development activities in a diverse range of 

neighborhoods that are struggling with persistent 

adverse birth outcomes.   

MATERIALS AND METHODS 
Curriculum Overview 

Our curriculum is grounded in transformative 

andragogy (Knowles, 1973), which is one of the 

foundations of modern adult learning theory 

(Merriam, 2001). Transformative andragogy proposes 

that adults learn differently than children based on 

four assumptions: changes in self-concept; the role of 

experience; readiness to learn; and orientation to 

learning. We incorporated the distinguishing 

characteristics of adult learning (Goad, 1982; Hanson, 

1981) into each module. As the curriculum builds 

through each module, it promotes a learning process 

where each participant is actively involved and 

responsible for his/her learning. Time and activities are 

given during each session for the GMCHL to reflect on 

their previous experiences and relate to what they are 

learning. The curriculum uses images and quotes to 

evoke emotional responses from the GMCHL and data 

to appeal to their intellectual learning. The goal is to 

combine the knowledge and expertise of the facilitator 

with that of the GMCHL, thus creating new knowledge 

for optimal community development work (Smith, 

Tiwari & Lommerse, 2014). Learning objectives were 

created using Bloom, Engelhart, Furst, Hill, and 

Krathwohl (1956) taxonomy. Learning objectives were 

designed to correlate with the MCH Leadership 

Competencies developed by the MCH Leadership 

Training Conference (2009). 

Every attempt is made to present the 

information at a level that is easily understandable as 

14.7% of adults lack basic literacy skills and 13.6% lack 

below basic literacy skills (National Center for 

Education Statistics, 2003). For GMCHL to be 

empowered as agents of change to improve MCH 

health outcomes, they need to be equipped with 

terminologies used at the public health, medical, and 

policy making levels. To this end, we define and use 

terminology that is used in the aforementioned 

sectors. As words or terms are identified that are 

unknown or confusing during the curriculum, we 



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

73 

create a vocabulary list for the GMCHL and work with 

them during mentoring sessions on the correct use of 

these terms. In addition, we will ask the GMCHL to 

provide lists of terms/phrases that are used to describe 

MCH conditions experienced in their community. 

Together we will develop health communication 

strategies to optimize the dissemination of MCH 

information in the community.  

The original draft of the curriculum was 

developed by a team consisting of: public health 

faculty, practicing nurses, physicians, social service 

providers, government public health workers, and local 

MCH non-profit leaders. The curriculum is divided 

into four sequential modules. All training and 

mentoring occurs in community sites that are easily 

accessible for participants. The knowledge content of 

the curriculum is centered around the following 

themes: leadership development and community 

health promotion, understanding adverse birth 

outcomes, health equity, and community and policy 

development. The initial training focused on these 

themes lasts four months. The curriculum allows for 

flexibility in scheduling and the GMCHL determine 

how and when they complete the sessions. During the 

initial four months, the GMCHL will also be trained in 

the following skills to help them build their leadership 

capacity. 

Photovoice. The Photovoice method is a CBPR 

method used for the development and implementation 

of community health assessments and program 

planning.  Photovoice was successfully used to educate 

community leaders and policy makers about MCH 

issues in their neighborhoods (Wang & Burris, 1997). 

Each GMCHL will be trained in the Photovoice method 

and provided a digital camera to document strengths 

and concerns of their community. Trained program 

staff will facilitate discussion of the photos utilizing the 

following questions: what do you see here, what is 

happening here, how does this relate to your life and 

the lives in the neighborhood, why does this situation, 

concern, or strength exist, and what can we do about 

this?  

Storytelling. GMCHL will complete multiple 

storytelling workshops led by collaborators from the 

Department of Anthropology. This process helps the 

GMCHL develop skills in telling their personal story 

and the story of their neighborhood. The training 

sessions will cover the fundamentals of good stories, 

interview tips, writing exercises, and an opportunity 

for the GMCHL to draft their own story.  

Policy Advocacy. Our partner, the Indiana 

Institute for Working Families provided curriculum to 

teach the GMCHL skills in policy development and 

advocacy. Following training, they will help GMCHL 

form partnerships with their local representatives to 

begin policy advocacy for MCH promotion.  

EvaluLead. The EvaluLead model will be used 

to guide and evaluate community priorities. This 

evaluation tool was developed by a partnership of the 

Public Health Institute, the W.K. Kellogg Foundation 

and the US Agency for International Development 

(Grove et al., 2005). The tool utilizes an open-systems 

approach for guiding and evaluating community 

leadership development based on values, norms and 

performance factors, and results in leadership goals at 

community, organizational and individual levels.  



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

74 

The goal is that after the four months, the 

GMCHL will have the foundation to begin their work 

while being continuously mentored.  

Soliciting Curriculum Feedback 

To ensure that our curriculum is 

comprehensive, we solicited input from 26 community 

members that represent a wide range of age, 

race/ethnicity, work expertise (grassroots citizens 

passionate about MCH, local health and social service 

providers, local government public health workers, 

non-profit leaders) and cultural backgrounds. In these 

sessions, we presented a summary of our initiative, 

themes from the four curricular modules, and key 

objectives and highlights from each module. A 

questionnaire was used for evaluation that included 

the following: name three things you learned from the 

information presented, what should we do better with 

this curriculum, how can grassroots leadership 

development impact the health of your neighborhood, 

what part of the curriculum did you find to be the 

most helpful, what part of the curriculum did you find 

to be the least helpful, how did the information 

presented change you, and has the information 

presented changed how you view the relationship 

between the characteristics of your community and the 

health of women, children, and families living in your 

community? Following the discussion of the 

questionnaire, an open discussion was held to solicit 

feedback driven by the participants. In addition to 

these community sessions, we received extensive 

feedback on the entire curriculum from: a child 

psychiatrist with a specialization in maternal and 

infant attachment, the lead case manager of Healthy 

Start for Marion County, and staff from the Indiana 

Institute for Working Families, the Urban League of 

Indianapolis and the Indiana Rural Health Association. 

A thematic analysis (Braun & Clark, 2006) was 

performed to synthesize the feedback from all of the 

community members. Changes were integrated into 

the curriculum.  

RESULTS 

Our results are organized by the four curricular 

modules, inclusive of feedback regarding each module, 

a detailed presentation of the learning objectives, 

correlation to MCH competencies (MCH Leadership 

Competencies Workgroup, 2009), knowledge and skill 

building activities and associated learning activities for 

each curriculum session.  

Module 1: Leadership in a Maternal Child Health 

Context 

Many reviewers expressed the importance of 

recruiting community members to be the main 

facilitators of building the capacity of the 

neighborhood to support healthy birth outcomes. 

Other feedback included the need to conduct a 

strengths asset analysis of GMCHL to help them 

understand their personal strengths from which to 

build their leadership. The overwhelming majority of 

reviewers expressed the great need for this MCH 

training approach that emphasizes skill building and 

action to complement the current work in Indiana. 

Using this feedback and the work of our team resulted 

in the curriculum details of module 1 (Table 1).  

Module 2: Adverse Birth Outcomes 



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

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Most reviewers expressed their great surprise 

at the persistent IM problem in communities across 

Indiana, especially those reviewers who resided or 

worked in several of the high-risk ZIP codes. In module 

two, the context of pregnancy is introduced to describe 

how the health of a woman before she becomes 

pregnant can determine how healthy her pregnancy 

will be. Some reviewers expressed the need to include 

information on interconception, family planning, 

depression [specifically the differences between 

depression, postpartum depression, and baby blues] 

and domestic violence. Other reviewers discussed the 

importance of teaching the GMCHL health 

communication strategies to disseminate the 

information they will learn to members of the 

community. Some reviewers expressed concern that 

the GMCHL would lack the ability to understand 

statistics such as IM, preterm birth, and low-birth-rate 

calculations. Using this feedback and the work of our 

team resulted in the curriculum details of module 2 

(Table 2).  

Module 3: Equity for All Babies 

Feedback for module three included the 

significance of sharing data on birth disparities and 

inequities in communities, defining disparity, equality, 

and equity, and sharing disparities in birth outcomes 

for people in Indiana based on race and geographic 

location. Two curriculum reviewers did not agree with 

sharing a table that showed similarities in birth 

outcomes in three high-risk Indiana ZIP codes with 

Iraq, Syria, and Libya as they were concerned the data 

were not accurate since it came from other countries. 

The same reviewers also did not agree with sharing 

statistics that showed African-American infants are 

two to three times more likely to die than their white 

peers. Their concern was that this did not properly 

highlight the work being done currently to reduce this 

disparity. However, the majority of reviewers discussed 

how important it is to share data with the GMCHL 

regarding all forms of birth disparities. The majority of 

reviewers also found it to be powerful to show that 

some of the high-risk ZIP codes in Indiana have similar 

or worse IM compared to our war-torn or politically 

unstable countries. Reviewers found it very helpful to 

discuss the impact of chronic stress on biological 

systems associated with pregnancy. They believed that 

this would be very helpful in validating the beliefs 

about stress observed throughout local communities. 

Using this feedback and the work of our team resulted 

in the curriculum details of module 3 (Table 3). 

Module 4: Power of Community Engagement 

The multi-sector reviewers found the use of 

storytelling and Photovoice to be powerful tools to 

capture the voice and story of the community. There 

was great consensus that the community realities 

surrounding IM are not prioritized in our state and 

that there is a paucity of community action approaches 

to complement health care approaches. Feedback was 

given concerning the type of questions the GMCHL 

would answer during Photovoice, the amount of time 

they would have to take the photos, and the 

Photovoice training process. During this session the 

GMCHL also get introduced to using the EvaluLead 

tool to make their community leadership plan. Using 

this feedback and the work of our team resulted in the 

curriculum details of module 4 (Table 4). 



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

76 

DISCUSSION 

While developing this curriculum we received 

a wide range of feedback to ensure the curricular 

content is inclusive of all necessary topics. It was 

evident in receiving feedback from our multi-sector 

partners, that developing MCH community leaders is 

needed to build the capacity of the community to 

support positive MCH outcomes. It was widely 

acknowledged that building their skills (i.e. 

Photovoice, storytelling, policy development, 

EvaluLead) will equip them from just having 

knowledge to being able to act on the knowledge. 

Likewise, it was pointed out that GMCHL would foster 

new knowledge of healthcare providers and policy 

makers, thus helping them better perform their duties. 

It was widely acknowledged that community members 

are not usually incorporated into decision making 

discussions that impact MCH practices and policies for 

their community. Leaders who are from and/or based 

in their community better understand the challenges 

and strengths of their community. This allows for a 

better community needs assessment, priority setting, 

and identification of necessary solutions that 

ultimately leads to community development that 

better supports community members and their birth 

outcomes (Harper-Hannigan et al., 2017). One 

challenge we faced in developing this curriculum and 

its review process was accessing grassroots community 

members who could help in its development and 

review process. We often were presented with 

community organization leaders to provide feedback, 

but not grassroots community members who have 

direct or indirect experience with adverse birth 

outcomes. To overcome this, we worked in partnership 

with the Indianapolis Urban League to connect with 

community members who are participating in some of 

their programs. Our Urban League partner greatly 

supported this effort. She emphasized the lack of 

knowledge among citizens regarding infant mortality 

and the persistent disparities associated with this 

problem. She and the individuals she connected us 

with were vital in providing feedback regarding the use 

of data in the curriculum and the need for community 

leaders training.  

The main objective of the training curriculum 

is to provide GMCHL with the foundation necessary to 

begin their community efforts. These GMCHL will 

represent community as an equally important 

discipline in Indiana IM reduction strategies (Smith et 

al., 2014), filling the gap of grassroots community 

participation in decision making that influences local 

MCH outcomes. Our leadership development model is 

linked to the Smith, Tiwari & Lommerse (2014) 

community development framework, which posits that 

decision-making, empowerment, and participation are 

all necessary and continuous processes for community 

development and that “…community-based capacity 

building is both a prerequisite and an outcome of 

community development.” Through this framework, 

the social capital of the GMCHL will be further 

developed, thereby increasing their civic engagement, 

trust and reciprocity of fundamental information 

exchange between community members (Bourdieu, 

1986). Building community capacity in neighborhoods 

at risk for poor outcomes will result in an 

improvement to community members' abilities to cope 

with adversity and limitations, foster a sense of place 

(McMurray & Clendon, 2011) and help lead the 



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

77 

physical, social, economic or environmental 

transformation (Smith et al., 2014) of their 

neighborhood to support improved birth outcomes. 

It is widely recognized that access to data and 

its collective analysis by community members, 

researchers and clinicians is vital to the success of a 

community-based effort at improving health or social 

outcomes (Israel, Shulz, Parker, & Becker, 1998). Often 

community members do not have access to data that 

pertain to their communities, thus further isolating 

them from making informed decisions about their 

community needs. Throughout feedback sessions we 

learned that community members as well as health and 

social service professionals were not aware of the IM 

issues facing Indiana communities. Our training 

program will provide GMCHL with data that promote 

their basic understanding of Indiana’s adverse birth 

outcomes, their risk factors, and birth disparities 

impacting U.S., Indiana and local communities. With 

this foundational understanding, GMCHL will emerge 

as community experts who are skilled participants and 

decision makers in multi-sectorial MCH discussions.  

Clinical interventions alone cannot reduce 

infant mortality because birth outcomes, like overall 

health, are the product of one’s environment, 

opportunities and experiences (Collins, Wambach, 

David, & Rankin, 2009). Building a community’s health 

promotion capacity is essential to any coordinated 

effort aimed at improving and sustaining health 

outcomes (LaBonte, Woodard, Chad, & Laverack, 

2002). As evidenced by the gap in the literature, and 

feedback received from a wide array of individuals 

passionate about improving birth outcomes across 

Indiana, our priority to develop and mentor ZIP-code 

based GMCHL is not only unique but needed. We 

implemented a process to develop a curriculum that is 

adaptable to any community and addresses the many 

factors needed to be a successful GMCHL. As we begin 

to implement this by training community members, 

we will continuously seek their feedback on curriculum 

content and delivery to make sure we are optimizing 

their learning experience and future participant’s 

learning experiences.  

ACKNOWLEDGMENTS 
We thank our partners: the Harrison Center, 

Indiana Institute of Working Families, Indiana State 

Department of Health, Indianapolis Urban League, 

Marion County Public Health Department, Riley 

Children’s Foundation, Indiana Rural Health 

Association and everyone who took the time to review 

the curriculum and provide feedback.  

DECLARATION OF INTEREST STATEMENT 
The authors do not have any conflicts of interest.  



ENGAGE! / Vol. 1, Issue 1 Skinner/Grassroots Maternal 

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Table 1:  

Module 1 Components 

Learning Objectives: where applicable can accommodate MCH 

Learning Competencies (2009)

Knowledge (k), Skills (s), and Activity (a) components 

1. Describe the role that community leaders play in maternal and child

health development.

Individuals must be considered within their social environment (k). 

2. Define community capacity building and the importance in improving

local maternal and child health issues.

Characteristics of community-based health promotion programs (k). 
Importance of community leaders (k). 
Need healthy neighborhoods for healthy pregnancies, infants, and families 
(k) 

3. Define leadership development in the context of community capacity

building (MCH competency 2).

Define leadership (k). 
Command and Control, Servant, and Transformational leadership styles 
(k). 

4. Demonstrate ability to identify personal leadership skills (MCH

competency 2).

Self-reflection’s importance in leadership (k). 
Recognize inherent leadership qualities as well as those that need to be 
cultivated (s). 
Leadership style activity (a). 

5. Complete and analyze a personal strengths inventory to gain insight 

into innate personal leadership qualities (MCH competency 2).

Formulate self-reflection leadership skills (s). 
Strengths inventory of leadership skills (a). 

6. Recognize optimal health promotion programming requires action at

the individual, interpersonal, organizational, community, and public

policy levels.

Neighborhood is the agent for change (k). 
SEM of Health Promotion (Bronfenbrenner, 1994) (k).

7. Differentiate policy issues for women at various points in the lifespan. Women’s health across the lifespan (k). 
Policy concerns during child, teen, adult, and older adult years (k) 

8. Provide examples of the relationship between healthy communities and
healthy pregnancies. 

GMCHL provide examples from personal experience or learning that 
demonstrate the connection between healthy neighborhoods and 
pregnancies (a). 

9. Discuss intergenerational differences in life experiences and how this 
can shape different perspectives and conversations with community
members. 

Traditionalist, Baby Boomer, Generation Xer, and Millennial generations 
(k). 
Highlight historical events that happened during different generations (k). 
Introduce common values held by each generation (k). 
Introduce the idea that our life experiences shape who we are, how we 
view the world, and communicate (k). 



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Table 2:  

Module 2 Components 

Learning Objectives: where applicable can accommodate MCH 

Learning Competencies (2009)

Knowledge (k), Skills (s), and Activity (a) components 

1. Define infant mortality, preterm birth and low birth weight (MCH
competency 4).

Learn current CDC definitions of IM, preterm birth, and low-birth-weight 
(k).

2. Discuss risk factors for adverse birth outcomes. Premature rupture of membranes, intrauterine infections, genetic 
abnormalities, multiple pregnancies/fertility treatments, birth spacing, 
maternal age, history of preterm birth, chronic stress, drugs of abuse, and 
domestic violence (k).

3. Compare/contrast the context of pregnancy for women in the USA and
Indiana. 

Learn current March of Dimes and NIMH data given on national and IN 
rates of obesity, depression, late or no prenatal care, smoking and binge 
alcohol use for women ages 18-44. (k). 
Discuss similarities/differences in data (a). 

4. Differentiate depression, postpartum depression and baby blues. Learn current NIMH and CDC definitions of depression, postpartum 
depression and baby blues (k). 
Discuss similarities/differences (a).

5. State what to do if someone is severely depressed or suicidal. Share National Suicide Prevention Lifeline and treatment options (k). 
Discuss what to do in crisis (a).

6. Describe difficulties preterm infants can have later in life if they survive
infancy.

Cerebral palsy, blindness, hearing loss, and learning, breathing, or feeding 
problems (k). 
Differences in infant brain at 31 and 40 weeks (k).

7. Explain the importance of maternal-infant attachment and why
communities should support this bond.

Foundational for physical, cognitive, and emotional development and 
provides benefits for mothers, infants, children, families, and communities 
(k). 
Poor attachment can cause behavioral disturbances, poor peer 
relationship, feeding difficulties, and emotional regulation problems (k). 
Communities must support healthy maternal-infant attachment (k).

8. Contrast unsafe infant sleeping with safe infant sleeping. 1/16 infant deaths in Indiana are due to unsafe infant sleeping that are 
100% preventable (SUIDs not SIDS) (k). 
AAP’s (2016) ABCDE’s of safe sleep (k). 
Discuss safe and unsafe infant sleep images (a). 

9. Identify infant sleeping myths. Four myths: they will choke lying on their back, they will catch a chill, I 
bond best sleeping with my baby, and it looks like a prison (k)). 
Discuss other myths they have heard and how they might refute them (a). 

10. Distinguish differences in how infant mortality, preterm birth, and 
low-birth weight rates are calculated.

Teach current CDC calculations of IM, preterm birth, low-birth-weight 
(k). 

11. Compare/Contrast differences in infant mortality, preterm birth, and
low-birth weight rates at the national, state, county, and local levels. 

Learn current March of Dimes infant mortality, preterm birth, and low-
birth-weight data for U.S., Indiana, the county of the GMCHL and the ZIP 
code of the GMCHL (k). 

12. Identify Indiana priorities for reducing infant mortality. Unsafe infant sleeping and premature birth (k). 
13. Identify Indiana priorities in accessing services. Prenatal care, WIC, mental health care, transportation, physical activity, 

and smoking reduction (k). 
Discuss where people in their community go for these services (a). 

14. Rehearse a sample presentation wherein you have to teach the local 
community members about infant mortality, preterm birth, low birth
weight, and their associated causes and consequences. (MCH competency 
4). 

Principles of health communication (k). 
Develop skills in presenting data and information to lay audiences (s). 
Develop skills in public speaking (s). 
Present to the facilitator and other GMCHL (a). 



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Table 3:  

Module 3 Components 

Learning Objectives: where applicable can accommodate MCH 

Learning Competencies (2009)

Knowledge (k), Skills (s), and Activity (a) components 

1. Discuss the range of disparities in health outcomes and discuss how
health equity is applied to address this. (MCH competency 2).

Use Whitehead (1991) definition of disparity, equality, and equity (k). 

2. Contrast race and ethnicity. Learn definitions of race and ethnicity (k). 
Discuss their thoughts on race and/or ethnicity (a).  

3. Differentiate birth outcomes in the USA, Indiana, and globally within
the context of disparities.

Comparative analysis of birth outcomes across race/ethnicity, immigrants, 
global community (k).  

4. Discuss the different types of birth disparities in their community. Highlight ZIP-code specific birth disparities for their community (k). 
5. Contrast differences between acute and chronic stress. Compare/contrast acute, chronic, minor, and major types of stress (k). 

Show the effects of chronic minor and major and acute major stress on the 
body’s hormonal, cardiovascular, and immunological systems (k). 
Provide examples of chronic minor and major and acute major stress’s 
effect on pregnancy and birth outcomes (k). 

6. Complete a personal adverse childhood experiences (ACES) survey to
increase awareness of the range of life experiences that contribute to
chronic stress. 

Recognize how incidents that happen to us as children shape our lives 
later on (k). 
Continuation of the self-reflection process. Looking internally to see how 
their experiences have shaped their lives (s). 
ACES activity (a)

7. Explain how chronic stress is related to birth disparities and differences
in maternal and child health outcomes for different communities and 
groups of people.

Discuss how chronic stress reduces an individual’s ability to make healthy 
choices especially regarding smoking, diet, exercise, alcohol, or illicit drug 
use (k). 
Changes in the neuroendocrine, vascular, and immune-inflammatory 
pathways can impact a mother’s pregnancy leading to adverse birth 
outcomes (k).

8. State ways to reduce chronic stress. Identify stress reduction techniques (k). 
Discuss advice they would give others to reduce stress (a).

9. Develop a list of community resources that can be used to promote
equitable birth outcomes (MCH competency 3).

Create a list of community resources and assets that can address barriers 
to MCH promotion (a).



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Table 4:  

Module 4 Components 

Learning Objectives: where applicable can accommodate MCH 

Learning Competencies (2009)

Knowledge (k), Skills (s), and Activity (a) components 

1. Outline one's role as a grassroots maternal and child health leader to 
build the capacity of their community to improve birth outcomes and
maternal and child health.

Define aim as building community capacity to support healthy women, 
infants, and families (k). 
Community members must identify the problems, solutions, and action 
plans (k). 
This empowers the community and improves the individuals’ health 
status, behaviors, and coping (k). 
Share community-based model (k).

2. Apply knowledge of the social ecological model in suggesting ways to
improve maternal and child health in their community.

Re-introduce SEM model (k). 
Develop skills in identifying MCH in the different levels of the SEM (s).  
Have GMCHL identify ways to improve MCH health in each level of the 
SEM (a).

3. Develop appreciation of being a mindful leader. Discuss importance of being mindful as a leader (k). 
4. Practice mindfulness exercise and describe how to incorporate this into
daily activities.

Mindfulness exercise (k). 
Develop skills in being a mindful leader (s). 
Mindfulness activity (a).

5. Summarize importance of storytelling as it pertains to maternal and
child health.

Storytelling can be used to make a point or convey a message and to 
facilitate discussions (k). 
Being a good leader means listening to others’ stories (k).

6. Develop, in an impromptu session, a personal story that highlights the
need for taking actions to improve birth outcomes (MCH competency 5).

Developing storytelling skills (s). 
Present a story (a).

7. Describe goals and basic practice of Photovoice. Describe process of Photovoice (k). 
8. Discuss the use of Photovoice to improve birth outcomes in your 
community.

Discuss 4 guiding questions of Photovoice: who makes up families in your 
neighborhood, document “mom’s story” with 3 pregnant women and 3 
mothers, what are sleeping environments of babies in your neighborhood, 
and what is your role as a change agent in the community (k, a).

9. Describe basic process of policy development (MCH competency 12). The following information is provided by Indiana Institute for Working 
Families: The composition of the Indiana House of Representatives and 
the Senate, registering to vote, identifying IN lawmakers, how a bill 
becomes a law in Indiana, and how to approach their lawmaker (k, s, a).

10. Differentiate policy issues for women at various points in the lifespan. Childhood: preschool, brain development, immunizations, and family 
support (k). 
Teen years: prevention of STD’s, pregnancy, and smoking, drugs of abuse, 
and alcohol use (k). 
Adulthood: interconception, preventative health services, child raising, 
quality childcare, and parental support (k). 
Old adulthood: raising grandchildren and managing chronic diseases (k). 
Discuss different policy issues for women across the lifespan that are not 
included (a).

11. Identify a policy to improve women's health and a personal strategy to
advance this policy (MCH competency 12).

Help them develop skills in making a policy action plan (s). 
Identify a policy that they would like to advance to promote MCH (a).



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82 

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	Abstract
	Introduction
	Materials and Methods
	Results
	Discussion
	Acknowledgments
	Declaration of Interest Statement
	References

