Introduction:

2) Community consultation meeting [Table 2]

3) Faculty and Stakeholder Consultations

This study aimed to develop a culturally tailored Maternal and Child (MCH) Handbook for Shelby County, Tennessee. The effort was driven by the region’s high maternal and infant mortality rates, particularly affecting African American populations. Building on the success of similar handbooks used internationally, the project team aimed to develop a locally relevant version that could improve health outcomes.

Using the MCH Handbook includes essential information like maternal care, childbirth records, and child checkups as a foundation, the researchers gathered input from healthcare providers, community leaders, university faculty, and families. This collaboration led to a handbook that addressed both clinical and social needs, such as breastfeeding guidance, immunization schedules, mental health support, and local health services.

Community feedback promoted the inclusion of sections for fathers, a pictorial development tracker, and myth-busting messages to reduce stigma around issues like vaccines, autism, and genetic conditions. The final design emphasized accessibility. Offering the handbook in multiple languages and formats. Overall, the handbook was developed as a practical, culturally appropriate tool to improve communication, support informed decision-making, and strengthen maternal and child health across Shelby County.

Discussion

The Maternal and Child Health (MCH) Handbook has played a pivotal role in advancing maternal and child health services globally, with notable implementations in countries such as Japan (Morioka et al., 2022).

As early as 1948, Japan published the MCH Handbook, becoming the first country to institutionalize it. With its ability to provide a thorough record of mother and child health history, encompassing prenatal, delivery, postnatal care, and child growth, it eventually became an essential part of Japan's MCH practice. Encouraging a national reduction in child and maternal mortality because of early intervention and regular record keeping (Morioka et al., 2022). Promoting parental education and community-based care via policy integration and government assistance, such as the 2016 and 2019 amendments to the Maternal and Child Health Act.

Three pilot provinces in Angola adopted a culturally specific MCH Handbook with assistance from Japan's JICA. First, a collaborative strategy that incorporates strong stakeholder engagement from the start and localized content design (Kuramata et al., 2022). The second is the incorporation of health education into regular service delivery, with a focus on underserved and rural communities. Finally, there has been evidence of a rise in the use of MCH services and the ownership of home-based health data, particularly among less literate women. These applications demonstrate the value of the MCH Handbook in strengthening health system integration at the institutional and community levels, promoting continuity of care, and enhancing health-seeking behavior.

The Maternal and Child Health (MCH) Handbook of Brazil is an essential component of the nation's health system, emphasizing maternal and child health. It was formed as a component of the nation’s larger plan to enhance maternal and child health results. The project was formally incorporated into Brazil’s Unified Health System (SUS) in the late 1990s (Ministry of Health, 1994). This personal health record facilitates ongoing care for expectant mothers and children, allowing healthcare professionals to track their health throughout pregnancy, delivery, and early childhood, thereby enhancing the quality of care and health results. Brazil’s MCH Handbook's essential elements included individual Health Records, such as pregnancy details, antenatal and medical appointments, childbirth data, postpartum details, postpartum support, child development, and vaccinations, alongside growth milestones, fostering continuous care, public health impact, and governmental support.

The Shelby County Maternal and Child Health (MCH) Handbook is expected to present numerous important innovations in comparison to earlier MCH handbooks, drawing from effective examples seen in other areas. These advancements may result in improved healthcare services and maternal-child outcomes in Tennessee.
Integration of Health Records: Earlier MCH handbooks often relied on various, disjointed health records (such as prenatal cards, vaccination records, and growth charts), which could lead to confusion or underutilization (Nambiar et al., 2023). In contrast, the MCH manual for Shelby County consolidates all maternal and child health records into one document, streamlining the process and fostering uniformity throughout various phases of care (Kuramata et al., 2022). This integration is advantageous as it enables simple monitoring of health indicators, enhancing the utilization and continuity of maternal and child health services.

Emphasize Health Education: Earlier MCH books were largely utilized for documentation, providing minimal room for health education and advice. The revised MCH handbook for Shelby County, however, is expected to focus more on health education, featuring clearer, more comprehensive sections on subjects such as prenatal care, indicators of complications, and baby care (Mahoney et al., 2021). These modifications guarantee that mothers and families receive comprehensive information regarding optimal prenatal care, postnatal health, and infant care, which could result in healthier pregnancies and enhanced child development.

Engagement with Community and Healthcare Providers: A significant innovation in the MCH Handbook for Shelby County is its emphasis on community participation and the training of healthcare providers, similar to practices seen in countries such as Angola. This method involves participatory workshops to collect input from mothers, healthcare professionals, and local stakeholders (Kuramata et al., 2022). This guarantees that the handbook addresses the requirements of the community it supports and that healthcare professionals are more prepared to utilize it efficiently. This model is expected to aid Tennessee by increasing healthcare access and advancing the education of local healthcare professionals, which will ultimately result in improved maternal and child health outcomes.

Flexibility and Adaptability: A further novel aspect of the MCH handbook for Shelby County is its capacity for adaptation. Drawing from experiences in different areas like Angola, this model is crafted to be adaptable, permitting modifications according to practical application and continual input from healthcare professionals and the families they assist (Kuramata et al., 2022). This flexibility is essential for tackling local health issues, like those encountered in Tennessee’s rural and urban areas, and for guaranteeing that the program can change according to new health trends or the community needs.

These attributes, along with a focus on enhancing healthcare accessibility, training healthcare professionals, and equipping families with practical health information, building on the already adaptable nature of previous MCH handbooks in many countries. They possess the ability to enhance the MCH Handbook for Shelby County by enhancing continuity of care, increasing health literacy, and boosting family involvement in their health management.

The Shelby County Maternal and Child Health (MCH) Handbook showcases a robust, cooperative initiative that emphasized the importance of community feedback. By conducting key informant interviews, focus group discussions, and consulting with healthcare professionals and university faculty, the handbook was comprehensively modified to align with the cultural values, unique needs, and resources accessible to the local communities.
Community engagement was crucial in influencing the content. Parents, particularly mothers and fathers of small children, stressed the importance of having explicit instructions on breastfeeding methods, identifying concerning symptoms in babies, and tackling the emotional and psychological difficulties associated with postpartum depression. The involvement of fathers and other relatives was especially significant, emphasizing their supportive functions in caregiving, like assisting with infant care and joining mothers at medical visits.

A highly useful addition was the birth planning segment, which provides expecting parents with organized advice on getting ready for delivery, such as selecting a healthcare provider, organizing transportation, and locating possible blood donors. This proactive strategy enhances readiness and lowers anxiety regarding childbirth.
Furthermore, a fresh visual resource on developmental milestones assists parents in monitoring their child's advancement from birth to five years old. The healthcare provider suggested phrasing to address stigma and incorrect information related to autism, vaccinations, and Down syndrome. These explanations assist in alleviating parental guilt and strengthen an evidence-based comprehension.
In general, the MCH Handbook functions both as an educational resource and as a source of empowerment. The handbook aids informed decision making and fosters better health results for mothers and children throughout Shelby County by integrating feedback from the individuals it is designed to assist.

Conclusion

The MCH Handbook serves as an educational tool and a means of empowerment by providing a standardized and comprehensive tool that integrates health records and education. By incorporating feedback from those it is intended to serve, the handbook supports informed decision-making and promotes healthier outcomes for mothers and children across Shelby County, TN, USA.  Addressing healthcare access inequalities and promoting the MCH Handbook will contribute significantly to achieving better health outcomes for mothers and children (Morioka et al., 2022; Nambiar et al., 2023) not only in Shelby County, but in counties and areas similar demographically, both domestically and internationally. We recommend the use of the MCH Handbook with culturally appropriate content as an effective strategy to support the well-being of mothers and children, ensuring continuity of care and leaving no one behind.

Acknowledgement:

CoRS Grant Support, University of Memphis, TN, USA., Research Team and Participants, and Contributors.