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Research Opportunity Announcement

OTA-20-014-C

IMPROVE Community Implementation Program (IMPROVE-CIP)

Solicitation for Research Coalitions

Purpose

The purpose of this new research opportunity announcement is to advance the goals of the NIH 

Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) 

Initiative. IMPROVE aims to understand the biological, behavioral, environmental, sociocultural, 

and structural factors that affect pregnancy-related and pregnancy-associated morbidity and 

mortality and build an evidence base for improved care and outcomes. The initiative promotes 

research to address health disparities associated with pregnancy-related and pregnancy-associated 

morbidity and mortality.

This Research Opportunity Announcement (ROA) intends to stimulate dissemination and 

implementation research on innovative approaches built on evidence-based findings from 

foundational research on factors that ultimately contribute to reducing maternal mortality (MM) and 

severe maternal morbidity (SMM). This ROA will support the development and testing of

promising community-based implementation strategies to inform integrated efforts to increase 

adoption, uptake, scale up and scale out of evidence-based interventions to improve pre-pregnancy, 

pregnancy, perinatal, and postpartum care and advance maternal health and maternal health equity

in disproportionately impacted and underserved communities. Leveraging community partners will 

advance a holistic and inclusive approach to identify, develop, and conduct promising communityengaged implementation research for the delivery and uptake of evidence-based interventions, at 

both the individual and community levels. Applications are expected to include a strong focus on 

community partnerships. Detailed plans to engage with relevant community organizations as full 

partners in the project are required for these implementation projects.

IMPROVE-CIP is a phased mechanism. Phase I is for conducting formative work as described 

below and is not intended for formal testing and evaluation of dissemination and implementation 

strategies. Tests of clinical effectiveness are also not appropriate for Phase I. Phase II is intended for 

the fully-powered testing of dissemination and implementation approaches. This ROA is for support 

of Phase I only. Availability of funds for full-scale testing of the most promising of these 

implementation strategies from the Phase I awardees will be considered at a later phase (Phase II), 

under a separate funding opportunity and subject to the availability of funds [Note: Phase II is not to 

be proposed, budgeted for, or awarded under this Phase I funding announcement, except as 

described below in the Application Requirements/Evaluation Criteria section]. 

Background

The maternal mortality (MM) rate has been rising in the U.S. and is now higher than any 

developed country in the world. Approximately 700 individuals die each year from conditions 

related to or associated with pregnancy or childbirth. At the height of the pandemic in 2020, 
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there were approximately 860 maternal deaths in the United States1,2. In addition, severe 

maternal morbidity (SMM)3, considered a “near miss” for MM, affects more than 65,000 

individuals in the U.S. per year. Individuals experiencing SMM are at increased risk for future 

adverse health (e.g., cardiovascular disease, diabetes, mental health conditions, strokes, and 

heart disease). Causes of SMM and MM are multifaceted. In the U.S., the leading causes are 

cardiovascular disease, infection, overdose, hypertensive disorders, thromboembolism, and 

hemorrhage. Birthing individuals with underlying disease such as kidney disease, lupus and 

others also increase risk for MM/SMM. Significant contributing factors include comorbid 

conditions (e.g., obesity, diabetes, mental health, and substance use disorders) as well as

interpersonal (e.g., intimate partner violence), structural and social (e.g., policies, neighborhood 

characteristics), and health care system factors (e.g., mistrust of the healthcare system, access to 

care, quality of care). It is estimated that 60 to 70 percent of maternal deaths in the U.S. are 

preventable.

Several factors affect MM/SMM, including, age, disabilities, geographical location, and social 

determinants of health (SDOH), education, structural racism and discrimination, neighborhood 

and built environment, housing stability, and social and community context. Psychosocial 

factors, stress, social isolation, mental health, intimate partner violence, substance use, quality 

of life, and SDOH contribute to pregnancy-related and pregnancy-associated morbidity and 

mortality, particularly among women from racial/ethnic minority groups, less privileged 

socioeconomic status groups, and other underserved populations such as rural populations, and 

sexual and gender minorities. Structural racism and discrimination (e.g., residential segregation 

and homelessness which restrict access to healthcare and healthy living environments) have 

profound negative impacts on maternal health and well-being outcomes during pregnancy and 

up to one year postpartum. Structural factors that contribute to negative impacts include 

occupational segregation and barriers which limit access to health insurance, sick or maternity 

leave, and healthy working conditions (inclusive of contributing policies and human behavior in 

the workplace that impact these barriers) and criminal justice inequities that lead to a greater 

risk of incarceration or fewer legal protections for people who experience violence or trauma, 

amongst others. Therefore, implementing multifaceted strategies to address preventable 

contributors to MM/SMM in populations that experience health disparities (HDP) and 

conducting novel systems research examining the health care and community approaches to 

maternal wellbeing have the potential to drastically reduce pregnancy-related maternal deaths 

and decrease maternal morbidity.

High rates of pregnancy-related and pregnancy-associated morbidity and mortality 

disproportionately affect Black/African American and American Indian/Alaskan Native 

individuals. Mortality rates for Black women (55.3 mortality incidences per 100,000 live births) 

were nearly three times higher than White women (19.1)

2

. Most recently available AI/AN 

population data indicate mortality incidences are significantly higher than White women (2007-

2016 average 29.7 mortality incidences per 100,000 live births) 4. Additionally, there are 

disparities in maternal health outcomes by age and geographic region such as increased barriers 

1 https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html

2 https://stacks.cdc.gov/view/cdc/113967

3 https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2016/09/severe-maternal-morbidityscreening-and-review 4 https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w
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to care in more rural and medically underserved areas5. 

To understand the impacts and vulnerability of populations most affected by MM/SMM, broad 

engagement with communities is essential6. Community-engaged research provides the 

opportunity and ability to discern community-level and individual-level impacts. Communityengaged research for maternal health enables/facilitates identifying relevant community-level 

factors that could improve maternal health and informs the development of locally-driven 

solutions that are effective and sustainable in addressing the disproportionate effects of 

MM/SMM in/on the engaged communities. Therefore, community involvement and voices will 

be critically important to advance solutions for addressing challenges associated with 

MM/SMM. Because key subgroups of the individuals at risk for negative health outcomes 

during pregnancy are part of marginalized populations (e.g. substance users), plans for engaging 

so-called “hidden” populations are needed. 

IMPROVE-CIP seeks to empower communities across the US to be full partners in communityengaged research and to contribute assets to understand factors that contribute to health 

disparities related to maternal health; to measure the needs and priorities of the impacted 

communities across multiple sectors (such as health care and community settings) that would 

benefit most from improved maternal health; implement effective strategies to assess 

community knowledge; address misinformation and disinformation in the community; and 

finally, build trust and strong partnerships across various stakeholders that encourage maternal 

health. 

The NIH-wide IMPROVE initiative supports research on how to mitigate preventable MM, 

decrease SMM, and promote health equity. IMPROVE is a multipronged, innovative research 

initiative designed to understand and eliminate health disparities among populations 

disproportionately affected by severe maternal morbidity and mortality, including Black/African 

American, American Indian/Alaska Native, Asian American, Native Hawaiian/Pacific Islander, 

Hispanic/Latina populations, rural and geographically underrepresented populations, sexual and 

gender minorities, very young individuals, individuals of advanced maternal age, and people

with disabilities. 

Although there is much to be done for developing new interventions, numerous evidence-based 

prevention interventions currently exist that are not routinely taken up and delivered in many 

communities. As part of the IMPROVE initiative, this Research Opportunity Announcement 

(ROA) seeks applications that propose implementation science projects to mitigate preventable 

MM, decrease SMM, and promote health equity. Implementation science is the scientific study 

of methods to promote the integration of research findings and evidence-based interventions 

into health care practice and policy. The core of implementation science is not to ask what 

intervention should be used, but rather which strategies are most effective at improving uptake 

and adoption of interventions of known effectiveness while considering local context. Taking a 

life-course approach and addressing the structural, social, environmental, healthcare system, and 

behavioral factors associated with health disparities is fundamental to identifying and

implementing sustainable approaches that can prevent MM and SMM for all birthing individuals 

across the country. Among critical factors that contribute to preventable maternal morbidity and 

mortality are those associated with healthcare system access and availability, community-level 

5 https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#urban-rural 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497354/
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resources, provider-level constraints, and social determinants of health. 

While NIH continues its strong support of research on identifying and testing the efficacy and 

effectiveness of interventions for addressing conditions such as eclampsia, pre-eclampsia, 

hypertensive disorders of pregnancy, mental health disorders, substance use, and gestational 

diabetes, it is also essential to ensure that existing evidence-based interventions promoting 

health before, during, and after pregnancy are being delivered, accepted, and utilized for all 

individuals. The overall goal of this ROA is to study the use of strategies to adopt and integrate 

interventions of known efficacy and effectiveness into community settings to improve maternal

health outcomes before and during pregnancy and post-partum, specifically within populations 

experiencing health disparities as listed above.

Authority

This Research Opportunity Announcement (ROA) is issued with the goal of establishing a 

subaward to the “other transactions” agreement NHLBI awarded to Westat under 

OT2HL158287 pursuant to 42 U.S.C. § 285b-3.

Objectives

Within this ROA, NIH invites applications to plan and carry out projects to disseminate and 

implement evidence-based interventions or practices into community settings (e.g., workplace, 

school, place of worship) to advance a holistic approach to improve maternal health and maternal 

health equity in populations disproportionately impacted by MM/SMM. Applicants are 

encouraged to propose studies that include interventions with demonstrated efficacy for the target 

populations and demonstrated effectiveness in real-world settings. Strategies should include plans 

to identify and overcome barriers and facilitators and adapt to local contexts. Applications that test 

implementation strategies outside of the traditional clinic setting will be of higher programmatic 

priority.

Evidence-based practice areas of interest include behavioral interventions; prevention, early 

detection, diagnostic, treatment, and management interventions; and quality improvement 

programs, with emphasis on culturally and linguistically appropriate strategies for NIH-designated 

HDPs (https://www.nimhd.nih.gov/about/overview/). Of particular interest are evidence-based 

practices with demonstrated effectiveness that address MM/SMM related to structural-, social-, 

psychosocial-, cardiovascular-, metabolic-, infectious-, mental health-, substance use-, and 

infection and immunity-related causes.

Multidisciplinary, systems, and community-partnered implementation science approaches 

utilizing existing community-engaged partnerships to reduce severe morbidity and mortality 

related to and associated with pregnancy encompassing the pre-pregnancy, pregnancy and postpartum periods are encouraged. Innovative approaches that substantially incorporate trusted 

community partners, organizations, or institutions, such as public libraries, are encouraged.

The overarching vision of this ROA is to (1) engage organizations, networks, and researchers that

are firmly connected to, actively working with, and/or embedded in communities with maternal

health disparities, and (2) provide funding for the conduct of early-phase studies of communityengaged research to test implementation strategies related to the adoption, integration, scale up, 

and sustainability of implementation of interventions known to improve the health of birthing 
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people of reproductive age. IMPROVE-CIP coalitions are expected to work collaboratively with 

other coalitions and as appropriate with additional IMPROVE programs. This includes but is not 

limited to working with the IMPROVE Centers of Excellence, IMPROVE Implementation Science 

Hub, and the IMPROVE Data Innovation and Coordinating Hub. Coalitions should anticipate a set 

of common data elements and/or common outcome measures may be expected from all projects.

Implementation of evidence-based interventions

Areas of interest include but are not limited to:

• Testing strategies for implementing effective, multiple evidence-based maternal health care 

practices (e.g., Alliance for Innovation on Maternal Health (AIM) patient safety bundles) 

within community settings, and health care models to address structural determinants of health 

and health disparities of complex patients, diverse systems of care, for at-risk, NIH-designated 

health disparity populations. 

• Testing multi-level strategies for improved dissemination of evidence-based maternal health 

prevention, screening, early detection, and diagnostic interventions, as well as effective 

treatments, clinical procedures, or dissemination of culturally tailored evidence-based

guidelines into existing health care systems.

• Testing strategies to incorporate community-identified needs and patient reported outcomes 

(PROs) and patient preference information (PPI) of pre-pregnancy, pregnant, and post-partum 

individuals in the design, implementation, and dissemination of pregnancy- and maternal 

health care-related practices.

• Implementation studies addressing different components of the health care models (e.g., health 

care system organization, clinician decision support, clinical information system, patient selfmanagement support, delivery system design) which may include care coordination and 

linkage to treatment/services (e.g., behavioral health, Substance Use Disorders, mental 

health).”

• Testing strategies that target organizational structure, climate, culture, and processes to enable 

dissemination and implementation of clinical/public health information and effective 

interventions to improve maternal health and maternal health equity and reduce structural 

racism and discrimination among high-risk populations.

• Development and testing of dissemination and implementation strategies to improve maternal 

health and outcomes that are risk-specific for NIH-designated U.S. HDPs, which currently 

include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, 

Asian Americans, Native Hawaiians and other Pacific Islanders, socioeconomically 

disadvantaged populations, underserved rural populations, and sexual and gender minorities 

(https://www.nimhd.nih.gov/about/overview/).

Examples of evidence-based interventions include:

Implementation of any evidence-based intervention must be done in close partnership with the 

community and incorporate the needs, preferences, and cultural norms of the community in which 

the intervention is being delivered. This list is not exhaustive, but meant to illustrate some 

examples which could also include individual level, family or community level interventions. 

• Pre-pregnancy counseling: 

https://www.acog.org/clinical/clinical-guidance/committee-
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opinion/articles/2019/01/prepregnancy-counseling

• Pre-pregnancy healthcare: 

https://www.aafp.org/about/policies/all/preconception-care.html

• Screening for gestational diabetes: 

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestationaldiabetes-mellitus-screening

• Screening and prevention of preeclampsia: 

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose- aspirinuse-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia- preventivemedication and 

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/preeclampsiascreening

• Achieving optimal health in modifiable risk factors (e.g., weight management, smoking 

cessation): https://www.nap.edu/catalog/12584/weight-gain-during-pregnancyreexamining-the- guidelines, 

https://journals.lww.com/greenjournal/Fulltext/2013/01000/Committee_Opinion_No_

_548 Weight_Gain_During.47.aspx, and

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use- inadults-and-pregnant-women-counseling-and-interventions

• Antihypertensive therapy for mild chronic hypertension in pregnancy:

https://www.acog.org/clinical/clinical-guidance/practiceadvisory/articles/2022/04/clinical-guidance-for-the-integration-of-the-findings-of-thechronic-hypertension-and-pregnancy-chap-study

https://www.smfm.org/publications/439-smfm-statement-antihypertensive-therapy-formild-chronic-2-hypertension-in-pregnancy-the-chaptrial?fbclid=IwAR07cIW9QePMF6v_IJgkmofJ5dShBFUy1viaaNZW315g6tMQfVH8XhAZ54

• Appropriate use of safety bundles (e.g., Alliance for Innovation on Maternal health 

patient safety bundles): 

https://safehealthcareforeverywoman.org/council/patient-safety-bundles/maternalsafety-bundles/

• Stress management in low-income pregnant women:

https://www.sciencedirect.com/science/article/abs/pii/S0306453018308552?via%3Dihub

• Rheumatic and Musculoskeletal Conditions

https://www.rheumatology.org/Portals/0/Files/Reproductive-Health-Guideline-Final2020.pdf

• Pharmacotherapies for Opioid Use Disorder 

https://www.cdc.gov/pregnancy/opioids/treatment.html

Other subject areas such as kidney disease, substance abuse and overdose are welcome and 

encouraged. It is incumbent on the applicant to demonstrate the subject area and corresponding

intervention(s) have sufficient evidence to improve maternal health and are ready move to 

implementation.

Applications should not propose studies that are duplicative of implementation science projects 

funded by other federal agencies such as HRSA, AHRQ, and CDC.
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Key Considerations

Collaborative Research. Given the range of expertise that may be needed for conducting 

dissemination and implementation research, applicants are encouraged to leverage multidisciplinary 

teams of scientists and stakeholders.

Community Engagement. Investigators proposing implementation projects must engage community 

partners at the onset and throughout the project who can successfully partner, advise, and provide 

feedback to implementation strategy development and testing teams. This type of involvement must

include advice from the community, partnership in research, and shared leadership.

All projects are encouraged to leverage existing resources and expand community partnerships (e.g., 

Tribal governments and agencies, academic, private, safety-net health systems, other health systems, 

grassroots organizations, public health departments, community and faith-based organizations, and 

schools or childcare settings) to complete the study aims. Approaches such as team science, 

community-engaged research, participatory action research, and related approaches may be used to 

engage stakeholders and underserved populations throughout the research process. Study budgets 

should include funds for the community partners to be fully engaged and successfully participate in 

research design and implementation.

Key characteristics of dissemination and implementation (D&I) research:

• Consider and characterize the multi-level context and environment in which the proposed research 

will be conducted.

• Develop and/or use appropriate D&I related outcomes, measures, and analyses. Applicants are 

encouraged to review available resources and use standard measures and validated instruments 

where possible, rather than developing their own measures for each study.

• Incorporate outcomes relevant to patients, consumers, families, practitioners, administrators, and/or 

policymakers as applicable.

All applications must address how the proposed research impacts maternal health in HDPs and how 

it may contribute to achieving maternal health equity. Studies that examine or address multiple 

levels and domains of influence affecting maternal health, care, and access are strongly encouraged. 

(See the NIMHD research framework: https://www.nimhd.nih.gov/about/overview/researchframework/nimhd-framework.html as an example). Projects are expected to incorporate research 

strategies to address individual and structural factors (https://health.gov/healthypeople/objectivesand-data/social-determinants-health) that present barriers to adequate and timely health care.

To accelerate research, NIH encourages investigators to leverage ongoing significant investments 

made on domestic resources, cohorts, and research infrastructure studying pregnant individuals. NIH 

expects that investigators supported though this ROA will share their findings, approaches, methods 

and results including with the other anticipated new NIH initiatives established under IMPROVE to 

advance maternal health and maternal health equity and ultimately contribute to reducing MM and 

SMM. Indeed, results and lessons learned from the coalitions funded under this ROA could 

potentially help inform and shape the execution of other new IMPROVE initiatives, including the 

IMPROVE Centers of Excellence in Maternal Health Research.
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The NHLBI, on behalf of the NIH Maternal Morbidity and Mortality Task Force (MMTF), is 

soliciting applications to award several (approximately 4) coalitions under Phase I of 

IMPROVE-CIP. These implementation science research coalitions (RCs) are envisioned to be 

comprised of community-based entities [including but not limited to, academic institutions,

community-based health systems including Federally Qualified Health Centers (FQHCs), Indian 

Health Services (IHS) clinics, community primary care centers or networks, community-based 

participatory research centers, faith-based organizations, and other community-based

organizations] that will work together to develop approaches for testing implementation 

strategies to address maternal health disparities within their communities. It is expected that 

disproportionately impacted communities will vary in terms of the causes and potential solutions 

to the maternal health disparities. The implementation strategies for uptake of evidence-based 

interventions must be developed in close coordination with community partners. 

Additionally, RCs selected for Phase I should expect that there will be some harmonization of a 

minimal set of common data elements and at least one shared outcome measure even if the 

individual projects are not powered on that outcome measure. RCs selected for Phase I will be 

expected to work closely with the Westat Administrative Coordinating Center (ACC), a 

component of the Community Engagement Technical Assistance Center (CETAC) other 

transaction authority agreement, as sub-OT awardees.

The purpose of this Research Opportunity Announcement (ROA) is to support the preliminary 

work necessary to demonstrate the readiness and capacity of RCs to undertake investigations

of community-informed and community-engaged implementation strategies focused on 

prevention and reduction of disparities in maternal morbidity and mortality. The preliminary 

work (Phase I, under this award) entails mobilizing research teams and community partners

with existing and relevant expertise to complete all of the following activities specifically

focused on disparities in maternal morbidity and mortality:

• Community-informed assessments including:

• Needs Assessment to demonstrate unmet need in the community.

• Community Priorities Assessment to align evidence-based interventions with what 

is most important to the community.

• Asset Maps that provide a landscape analysis of existing community resources 

which can be leveraged to address MM/SMM.

• Identification of opportunities and barriers to acceptance, delivery, uptake of, and

adherence to evidence-based interventions and practices to address maternal 

morbidity and mortality.

Definitions

For the purpose of this ROA, note the following definitions. 

“Structural discrimination” refers to macro-level conditions (e.g., residential segregation) that 

limit opportunities, resources, and well-being of less privileged groups (Healthy People 

2020, https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinantshealth/interventions-resources/discrimination).

“Structural racism and discrimination (SRD)” refers to structural discrimination on the basis 

of race/ethnicity and/or other statuses, including but not limited to gender, sexual orientation, 

gender identity, disability status, social class or socioeconomic status, religion, national origin, 
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immigration status, limited English proficiency, or physical characteristics or health 

conditions. https://grants.nih.gov/grants/guide/rfa-files/rfa-md-21-004.html

“NIH-designated Populations with Health Disparities” (HDPs) refers to racial and ethnic 

minorities, socioeconomically disadvantaged populations, underserved rural populations, and 

sexual and gender minorities in the U.S. (see https://www.nimhd.nih.gov/about/overview/). 

Health NIH-designated U.S. health disparity populations include Blacks/African Americans, 

Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and 

other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural 

populations, and sexual and gender minorities7,8. This initiative also targets populations 

disproportionally impacted by maternal mortality including very young individuals, individuals 

of advanced maternal age, and individuals with disabilities. 

“Health care models” refers to the different existing or newly proposed models of patientcentered care. Examples of existing health care models include the Chronic Care Model, the 

eHealth Enhanced Chronic Care Model, the Community-Based Transition Model, the Nurse 

Management Model, the Home-Based Model, the Integrated Delivery Systems Model, the 

Patient-Centered Model and the Value-Based Care Models.

“Multi-level” refers to the multi-dimensional framework of determinants relevant to understand 

minority health and address health disparities. This concept is further described under the 

NIMHD Research Framework (https://www.nimhd.nih.gov/about/overview/researchframework/).

“Dissemination research” is defined as the scientific study of targeted distribution of 

information and intervention materials to a specific public health or clinical practice audience. 

The intent is to understand how best to communicate and integrate knowledge and the associated 

evidence-based interventions. Gaps include missing critical information about how, when, by 

whom, and under what circumstances evidence spreads throughout communities, organizations, 

front line workers, and consumers of public health and clinical services.

“Implementation research” is defined as the scientific study of the use of strategies to adopt 

and integrate evidence-based health interventions into clinical and community settings to 

improve individual outcomes and benefit population health. Implementation research seeks to 

understand the behavior of practitioners and support staff, organizations, consumers and family 

members, and policymakers in context as key influences on the adoption, implementation, and 

sustainability of evidence-based health interventions and guidelines (e.g., Community Guide to 

Preventive Services, U.S. Preventive Services Task Force, and clinical and professional 

societies' recommendations and guidelines).

For additional resources on dissemination and implementation research, including information 

on D&I training opportunities, funded studies, key references, past workshops and conferences, 

visit:

http://cancercontrol.cancer.gov/is/ and

https://prevention.nih1.gov/research-priorities/dissemination-implementation. 

For additional information on MM/SMM and the IMPROVE initiative at NIH, please visit:

https://orwh.od.nih.gov/mmm-portal and

https://www.nih.gov/research-training/medical-research-initiatives/improve-initiative.

7 https://www.nimhd.nih.gov/about/overview/

8 https://grants.nih.gov/grants/guide/notice-files/NOT-OD-19-139.html
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Scope

The RCs will leverage existing infrastructure and community partners and identify and develop

promising community-engaged dissemination and implementation research in disproportionately 

impacted and underserved communities. The purpose is to set the stage for the conduct of future 

investigations to more definitively test implementation strategies for the delivery and uptake of 

evidence-based interventions, at both the individual and community levels. Interventions are 

expected to address areas known to impact MM/SMM before, during, or after pregnancy.

This ROA is not intended to replace traditional NIH research funding mechanisms (e.g., R01, 

R21). The Period of Performance of this initial phase (also referred to in this announcement as 

“Phase I”) is expected to last for 2 years from the notice of award. Availability of funds for fullscale testing of the most promising of these implementation strategies from the Phase I awardees

will be considered at a later phase (Phase II), under a separate funding opportunity and subject to 

the availability of funds [Note: Phase II is not to be proposed, budgeted for, or awarded under 

this Phase I funding announcement, except as described below in the Application 

Requirements/Evaluation Criteria section].

Eligibility

Eligible applicants include, but are not limited to, domestic public or private entities, including 

academic institutions, community-based health systems including Federally Qualified Health 

Centers (FQHCs), Indian Health Services (IHS) clinics, community primary care centers or 

networks, community-based participatory research centers, faith-based organizations, and other 

community-based organizations, and tribal organizations. For-profit entities are not eligible to 

apply to this initiative, but may serve in a consultant role or be engaged as a contractor to 

eligible applicant entities. In these cases, the eligible applicant may use awarded funds from this 

initiative to pay a for-profit entity for services it receives in the conduct of its eligible work.

Applications are expected to:

• Include researchers with experience in implementation science, community- engaged 

research approaches, and health research activities with a demonstrated record of

successful maternal morbidity and mortality research, particularly in populations 

experiencing maternal health disparities.

• To reflect collaborative efforts and shared leadership, individuals from community 

partners should be identified as Key Personnel including a description of their 

contributions to the project.

• Demonstrate an understanding of the potential barriers to testing implementation 

strategies within their defined health disparity communities.

• Have an established infrastructure in place to support the development, 

implementation, and evaluation of the proposed implementation strategies.

• Have an identified coalition/collaborative made up of a multidisciplinary group of 

researchers with specific expertise noted above, as well as clinicians, public health 

experts, community-based organization representatives, and local leaders, identified as

partners in this effort to test promising strategies for implementation within their 

communities.

• Demonstrate a history of successful partnership efforts and/or research 

collaborations, that is reflective of shared leadership and shared resources, with at

least two or more member organizations comprising the coalition, including a 
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description of relevant projects.

Application Responsiveness

Examples of projects that will be considered responsive to this announcement include:

• Studies that focus on communities which have a disproportionate burden of severe 

maternal morbidity and mortality.

• Proposals to plan studies that will test multiple potentially effective implementation

strategies to improve uptake and adoption of evidence-based interventions.

• Proposals that include a broad research team of community engagement researchers 

and key community members, with at least one PI and/or key personnel from a nonacademic institution, a community-based organization or other community partners.

• Proposals that focus on maternal health issues or contributors to these problems that are a

priority for the community being studied.

• Proposals focused on testing implementing strategies for evidence-based interventions 

relevant to IMPROVE.

Examples of projects that will be considered unresponsive to this announcement include:

• Proposals that do not include a needs assessment study, community priorities assessment, 

and asset map.

• Proposals to test implementation of outdated guidelines or practices.

• Proposals to test implementation of interventions that are not evidence-based.

• Proposals to test efficacy of interventions. [Testing effectiveness of interventions is only 

allowed in the context of a Hybrid Type 2 or Type 3 Effectiveness-Implementation design9. 

Type 1 Hybrid designs are not responsive.]

• Studies to conduct research in a community without high burden of MM/SMM.

• Studies that are not focused on a health disparity population as defined above.

• Studies which do not include key personnel, and/or Co-Investigator or Multiple Principal 

Investigator from a community-based organization or community partner. 

Application Requirements/Evaluation Criteria

The application should include the following:

• The identified target population and geographic region for its proposed project and a 

description of the maternal health disparity in this population.

• Data that demonstrate the need for the proposed project; the project must address 

needs not being adequately met by current resources, infrastructure and 

implementation tools.

• A description of the coalition/collaborative structure and members, including existing 

and potential new members. Coalitions are required to include academic 

partners/researchers who have conducted community engaged research within those 

communities.

• A Project Plan with goals and objectives for the proposed project that align with the 

9 Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: 

combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical care, 

50(3), 217–226. https://doi.org/10.1097/MLR.0b013e3182408812
12

initiative’s goals and objectives; innovative approaches and the potential for sustainable 

strategies are desirable. The plan should propose a vision that clearly articulates how the 

approaches and findings from Phase I could be more fully tested in a potential Phase II

at a later stage [as noted above, Phase II is not part of the funding of this current 

announcement].

• A plan to conduct a needs assessment, community priorities assessment, and asset map

to identify barriers and facilitators to adoption of the evidence-based 

practice/intervention and to inform or refine proposed implementation strategies.

• A description of the evidence-based intervention(s) to be implemented within the 

community setting(s). Interventions may include programs, practices, processes, policies 

and guidelines.

• The proposed implementation strategies (systematic processes, methods or techniques to 

enhance adoption, acceptance, spread, adherence, and/or sustainability) to be tested 

within specific settings. Includes what the strategy intends to change; the level targeted

(individuals, inner setting, outer setting, processes); and the proposed barriers and 

facilitators of adoption and implementation.10

• A plan for low health literacy and limited-English proficiency as it impacts implementation 

within the community identified.

• The underlying theoretical framework or model (e.g., Diffusion of Innovations, 

Consolidated Framework for Implementation Research; RE-AIM),

11 and a description

of how implementation outcomes (e.g., feasibility, acceptability, fidelity, scalability, 

and the potential for sustainability) will be measured.

• The study design12 proposed to test and evaluate the implementation strategies and 

allowing for community engagement throughout the project.

• Resources requested, including research lead(s) and other staff, and their roles.

• Letters of commitment from key coalition/collaborative members that demonstrate a 

clear understanding of their roles as key personnel and/or partners in this project.

• A milestone-driven project plan to accomplish the goals of the project, as per the SOM 

(below), including risk management for disasters and public health emergencies.

Statement of Objectives and Milestones (SOM)

The applicant’s approach to achieving the following milestones will be described in the Project 

Plan and in the draft milestone-based workplan.

1. Project Management

The following project management activities are required:

• Develop a milestone-based workplan to be reviewed and potentially modified by the 

ACC, including proposed metrics of successful completion for each milestone.

• Participate in monthly teleconferences with the ACC and provide updates on status of 

milestone completion, including assessment of risks and challenges.

• Drawing on the workplan, as per direction by the ACC, compile and submit data and 

10 Leeman et al. Beyond “implementation strategies”: classifying the full range of strategies used in implementation science 

and practice. Implementation Science (2017) 12:125 Doi: 10.1186/s13012-017-0657-x 11 https://dissemination-implementation.org/ 12 Brown CH, Curran G, Palinkas LA, et al. An overview of research and evaluation designs for dissemination and 

implementation. Annual Rev of Public Health. 2017; 38:1 –22. Doi: 10.1146/annurev-publhealth-031816-044215 
13

benchmarks indicating achievement of the required key milestones; likely on a monthly 

basis to coincide with the monthly teleconferences with the ACC.

• Participate on the ACC Steering Committee (SC); assume at least two members

participating in quarterly teleconference meetings.

• Participate in the convening of meetings of project partners as needed to accomplish

the proposed project; e.g., patient advocacy groups involved in RCs may have the 

opportunity to participate in a sub-committee with other patient- or communitybased organizations.

• Participate in data collection activities conducted by the ACC in support of the 

evaluation of the RCs, including a mid-course portfolio evaluation of overall project and

individual RCs as well as a summative comprehensive evaluation. The evaluation may 

include a site visit from NIH and/or ACC staff to be conducted (either virtual or inperson).

• Data Sharing Plan: Consistent with achieving the goals of this program, the NIH expects 

that information such as collected data, technical protocols, and any other metadata 

collected under this ROA is to be deposited as appropriate into existing, publicly 

available data repositories that are easily accessible, and in machine readable format. 

Where appropriate, applicants should identify such repositories and plans for deposition. 

If applicants are proposing research within Indian Country or tribal communities, they 

must propose a data sharing plan that respects and enforces principles and practices of 

Tribal data sovereignty. The applicant is required to propose a data sharing plan that 

includes a description of how the Maternal Health Centers of Excellence will work with 

PD’s/PI’s and respect sovereignty-based data management and sharing requirements.

2. Study Design and Development

The following milestones are required to be completed during Phase I the award. Milestones may 

not be completed in Phase II (if awarded):

• Complete an acceptable community needs assessment, community priorities assessment and 

asset map.

• Identify and/or develop promising implementation strategies based on specific 

community needs and strengths.

• Refine and finalize Phase II study design, including recruitment/enrollment plan, data 

collection methods and measures, and analysis plans for quantitative and qualitative 

data.

• Identify potential barriers and mitigation plans related to achievement of the study aims 

within the specified community.

• Confirm the adequacy of study sample for Phase II.

• Apply for and obtain any required approvals (IRB, etc.) for Phase II.

• Finalize agreements pertaining to the execution of the initial work (e.g., letters of 

commitment, data use agreements, partnership agreements, etc.).

If pilot testing of implementation strategies and/or intervention refinement is planned during 

Phase I, the additional following milestones are required to be completed before the end of Phase I:

• Obtain IRB and other required approvals for Phase I testing.

• Implement early/pilot testing of identified implementation strategies and/or intervention 

refinement; collect and analyze pilot data on relevant outcomes including feasibility,

acceptability, fidelity, scalability, and the potential for sustainability.
14

• Deliver report of results of the pilot test to the ACC intermittently upon request and 

at the close of the period of performance.

NIH Assumptions

• NIH assumes that the RCs will maintain key personnel with qualifications equivalent to

those who were included in its final negotiated proposal throughout the duration of the 

award.

• NIH assumes the RCs will maintain fiduciary records in compliance with all appropriate

professional standards and federal regulations (as applicable) and in such a format as can 

be accessed by the government for review at any time.

• NIH assumes that each RC will seek and obtain Institutional Review Board (IRB)

approval at their local institution(s), as may be required, and provide evidence of

approval to NIH and/or the ACC upon request. Applicants proposing human subjects’ 

research must offer assurance that a Federal-wide Assurance (FWA) is in place.

Award and Selection Information

Awardees will be selected through an objective review process subject to NHLBI review and 

approval. Cost sharing is allowable and encouraged. The level of funding for any award(s) made

will depend on the quality and scope of the proposals received and availability of funds. 

Agreements for awards will be negotiated and managed by the NHLBI-funded Westat CETAC

with eligible entities whose proposals are determined through the review to be the most 

advantageous and provide the best value to the government.

The NHLBI, through Westat CETAC, reserves the right to:

• Select for negotiation all, some, one, or none of the proposals received in response to 

this ROA;

• Accept proposals in their entirety or to select only portions of proposals for award;

• Fund proposals in increments and/or with options for continued work at the end of one or 

more phases, which can consist of more than one milestone;

• Require proposers to coordinate and share data with the CETAC and with other 

research programs to be identified by the NHLBI;

• Request additional documentation (certifications, etc.); and remove proposers from 

award consideration should the parties fail to reach a finalized, fully executed agreement,

or the proposer fails to provide requested additional information in a timely manner.

CETAC 

Awardees of this funding opportunity are required to work as subawardees with Westat, Inc., 

NHLBI’s awardee serving as the Community Engagement Technical Assistance Center (CETAC). 

The purpose of the CETAC is to provide overall administrative management, support, technical 

assistance, and community engagement resources to increase the capacity of the NIH funded 

community engagement research initiatives and programs and to ensure that the research teams 

can convene as an alliance to synergize and benefit from cross-learning. The CETAC will support 

IMPROVE-CIP research teams by assigning site liaisons to monitor workplan progress, identify 

challenges and gaps, and assist awardees to compile data using timely and low-burden submission 

processes.

Special Award Terms

The complete terms and conditions of each sub-OT award issued under this ROA are subject to 
15

negotiation and will be contained in the Agreement entered between Westat (on behalf of 

NHLBI) and the IMPROVE-CIP awardee. This Special Award Terms section is provided for 

informational purposes only in order to provide prospective applicants with an understanding of

key expectations and terms that may differ from traditional NIH award mechanisms.

Lower Tier Agreements

The IMPROVE-CIP awardee will be expected to issue sub-awards to entities identified in their

proposals and approved by NHLBI under this ROA.

Payment Schedule

NHLBI funds issued under the sub-OT Agreement will be disbursed through Westat (CETAC)

based upon submission of monthly progress report to the CETAC with demonstrated progress 

towards work-plan milestones as well as attendance at regularly scheduled CETAC Liaison 

meetings.

Milestone-Based Workplan

All IMPROVE-CIP research teams are required to submit a draft milestone-based workplan in 

response to this ROA. The workplan should include a description of operational milestones, 

completion criteria, and expected start and completion dates. An “Operational Milestone” is an

objective, measurable event that is indicative of project progress occurring as proposed in the 

application. NHLBI, with the assistance of the CETAC, will review and approve the milestonebased work plan for inclusion in the sub-OT Agreement.

Quarterly Outcome Reporting

All IMPROVE-CIP teams will report on the following team outcomes to the ACC on a quarterly

basis, as applicable to IMPROVE-CIP project activities.

• The number and basic demographic characteristics of participants engaged in each

proposed activity to date.

• Outreach and ongoing collaboration activities with community partners

• Collect and submit common data elements to the ACC

Proposal Submission Process and Award Criteria

Required sections of the proposal (PROJECT PLAN, BIOSKETCHES, BUDGET, SITE 

AGREEMENT) will be submitted via the application page at www.MaternalHealthCIP.org. You 

must create a user account to upload your application. If you intend to submit a proposal, please 

create this account at least one business day in advance to ensure adequate time for your account 

to be activated. To create your account, please visit www.MaternalHealthCIP.org and click

“Register.”

The PROJECT PLAN and BUDGET should clearly and fully demonstrate the proposer’s 

capabilities, knowledge, and experience, and the budget proposed to accomplish the SOM. Use 

the Budget Template available at www.MaternalHealthCIP.org to prepare the project budget. 

Additional information on requirements for these two sections is provided below.
16

BIOSKETCHES should be combined into a single PDF file and uploaded separately.

A draft SITE AGREEMENT has been developed to facilitate the award process and is available

for download via the application page at www.MaternalHealthCIP.org. Please download and

review this agreement and make any necessary edits as required by your institution. The 

agreement, with any tracked changes, should be uploaded separately.

All components should be uploaded in searchable PDF format, single spaced, with a font size of 

11 or 12 point and font type of Arial or Times New Roman. Margins must be 1-inch wide (top, 

bottom, left, and right).

PROJECT PLAN. The project plan must include the following:

A. Understanding/need (3 page maximum; 15%)

This section describes the maternal health need, target population, and geographic region for its 

proposed IMPROVE CIP project, including data that demonstrate the need for the proposed 

project.

B. Investigative team and key personnel (4 page maximum per biosketch; 20%)

Proposers must demonstrate experience of key personnel, including community partners, 

supporting the planning and implementation of activities described in the SOM. Please describe 

staff who will be assigned to manage performance and supervise the work for each task and 

subtask (as appropriate), and identify the person who will serve as the primary logistical point of 

contact.

This section should also address the management/staffing plan, including how the proposer will 

provide the necessary project administration, organization, and staff to ensure quality control, 

compliance with SOM expectations, and necessary staffing adjustments. The applicant’s 

experience with and approach to conflict resolution, consensus building, shared leadership, and 

bilateral engagement in similar community-based projects should be emphasized.

A biosketch (preferred) or CV is required for key personnel; each must not exceed 4 pages in 

length. The NIH will review these biosketches/CVs to evaluate whether the individuals possess the 

required experience to perform the specific tasks.

C. Technical approach/scientific plan (12 page maximum; 40%)

The proposer must explain the technical methods and approaches it will take in accomplishing the 

goals of the ROA, including a description of the proposed study design. The proposer must 

demonstrate its understanding of the SOM by clearly showing a grasp of the range and the 

complexity of the tasks and how each will be accomplished. Proposers should demonstrate a 

conceptual understanding of the challenges specific to the tasks in the SOM and suggestions for 

overcoming these.

D. Resources and Environment (no page limit; 15%)

In this section, the applicant should describe the resources available to the project and environment 

in which the activities will be performed.

E. Additional required components of Project Plan

• Draft detailed milestone-based workplan (2 page maximum; 5%)

• Description of Phase II potential (1 page maximum; 5%)
17

BUDGET. Please use the budget template to prepare your project budget. This template is 

available for download via the application page at www.MaternalHealthCIP.org. The budget 

should reflect the proposed milestone-based payment schedule and total cost proposed, 

accounting for cost share amounts offered by the applicant. If proposing F&A, include a 

negotiated federal rate approval. There is no page limit for the budget. Proposers shall assume an 

award term of up to 24 months. 

The budget justification should be aligned with the goals and responsibilities outlined in the 

proposal. The budget justification should include the specific roles, responsibilities, and percent 

effort of personnel. Cost sharing is allowable and encouraged.

The direct costs, subcontract F&A (if any), and total costs for each year/partial year of the 

proposed project (funds and value of goods or services provided as cost share and by third- party

contributors) must also be included. A statement about any proposed third-party support, the 

estimated commitment level, and possible contingency plans in the event that the cost share or 

third-party support is terminated during the research project should also be provided.

Applications must provide a realistic, fully justified budget and cost proposal for performing the 

work over a specified period of performance needed to accomplish project objectives. Provide 

the overall expected cost for each of the following categories:

• Personnel

• Equipment

• Travel

• Subawards/subcontracts/consultants

• Other direct costs

• Total cost (with indirect costs included)

• Proposed Cost Share contribution

o Plan for issuing timely payments to community partners. The plan should detail how processes 

may differ for different partner types/agreements.

o Description of community partners, including partner type (such as public health departments, 

community service organizations, tribal organizations, academia, grassroots organizations, social 

service systems, health systems, safety-net clinics, schools, and other partners). Information on 

community partners should be provided in the following table format:

Partner 

Name

Agreement 

Type (e.g.

consultant 

agreement,

sub contract, 

MOU)

Partner Type 

(see examples 

above)

Brief 

Description of 

Role on 

Project

New or 

Established 

Partner

Included 

in Budget 

(Y/N)
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Roles and Responsibilities

The IMPROVE-CIP Awardee will:

• Develop and address project specific milestones and anticipated outcomes of the

proposed research.

• Collect metrics to demonstrate impact and outcomes throughout the project period of

performance as well as the potential for sustainability beyond the project time frame.

• Provide representatives to participate in ACC Steering Committee meetings, Work Groups, 

Interest Groups and other ad-hoc meetings.

• Submit monthly and quarterly reports as requested by the ACC.

• Participate in monthly project monitoring meetings with the ACC.

The ACC (CETAC) will:

• Support IMPROVE-CIP awardees by monitoring workplan progress; identifying

challenges and gaps and identifying resources to address challenges as appropriate.

• Provide technical assistance/support in evaluation, and communications.

• Provide scientific and logistical support to NHLBI and this project as a whole on emerging

scientific needs related to these topics, including convening working groups and 

committees.

• Provide technical assistance/support in evaluation and communications to advance the

milestone- driven phases of project execution for IMPROVE-CIP awardees.

• Oversee IMPROVE CIP sub-OT awards, including distribution of tranche funding

tied to submission of monthly reports.

• Conduct an evaluation of the overall project and individual IMPROVE-CIP awardees.

NHLBI (NIH) will:

• Provide ultimate oversight, guidance, and monitoring of IMPROVE-CIP projects.

Submission and Contact Information

Submission in response to this ROA requires creating a user account and submitting a full and 

complete proposal using the Maternal Health Community Implementation Project (MH-CIP) 

website, www.MaternalHealthCIP.org.

Proposals received by 6 PM EDT on December 16, 2022 will be reviewed by February 17, 2023 

Proposals received by 6 PM EDT on February 17, 2023 will be reviewed by April 14, 2023.

Proposals received after February 17, 2023 will be reviewed on an ad hoc basis.

Questions:

Financial and administrative questions should be addressed to Erynn Huff, JD, NHLBI

Agreements Officer at: erynn.huff@nih.gov with a copy to: NHLBI_OTA@mail.nih.gov.

Technical questions should be addressed to Dave Clark, DrPH., NHLBI Scientific Program 

Director at Dave.Clark@nih.gov.