IntroductionText messaging interventions (TMI) are promising for addressing heavy episodic drinking (HED) in non‐treatment‐seeking postpartum women. Their anonymous delivery can overcome fear of consequences that often prevents postpartum women from seeking treatment for HED. We assessed feasibility and acceptability of text messaging to inform the development of a tailored TMI for postpartum HED.MethodsWe surveyed 165 postpartum women recruited via a national Qualtrics panel on their drinking behaviours, mobile technology use and TMI preferences.ResultsTwenty‐five percent of the sample (N = 41) were classified as heavy episodic drinkers, with significant drinking reported before, during and after pregnancy, supporting the need for intervention. Feasibility of text messaging was supported by nearly universal mobile phone ownership and text messaging. Attitudes and intervention preferences varied, with 30% of HEDs likely to participate in an intervention asking them to receive automated messages, and 46% likely to participate in an intervention that included live texting with a counsellor. Respondents were more likely to participate in a study that asked them to respond to messages about mood and stress (63%) than daily drinking behaviours (35%), and were most interested in a TMI that included live texting with a counsellor. Nearly half the sample endorsed fear of child removal as a significant barrier to participation.Discussion and ConclusionsFindings support the feasibility of text messaging as an intervention approach for postpartum HEDs. Postpartum women may have unique concerns and preferences that differ from other groups of HEDs, making a user‐centred design approach critical.
Background Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID) PRR1-10.2196/36849
Background Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e–SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e–SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e–SBI-HV prototype and describe the e–SBI-HV prototype. Methods Adaptation of the original e-SBI into the e–SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e–SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results The e–SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor–client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e–SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. Conclusions This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e–SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e–SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e–SBI-HV.
BACKGROUND Perinatal substance use (SU) is prevalent and may increase risks to maternal and child health. Many pregnant and postpartum people do not seek treatment for SU due to fears of child removal. Home visiting (HV), a voluntary supportive program for high-risk families in the perinatal period, is a promising venue for addressing unmet SU needs. Confidential delivery of screening and brief intervention for SU via computer has demonstrated high user satisfaction among pregnant and postpartum people as well as efficacy in reducing perinatal SU. This study describes the development of Electronic Screening and Brief Intervention for Home Visiting (e-SBI-HV), a digital screening and brief intervention program that is tailored to the HV context. OBJECTIVE Study objectives are to (1) describe the user-centered intervention development process that informed the development of e-SBI-HV components; (2) present the results of qualitative interviews with home visitors and clients that informed e-SBI-HV development; and (3) describe the e-SBI-HV prototype. METHODS e-SBI-HV development followed a user-centered design process that included iterative cycles of interviews with home visitors and clients. Feedback gathered during each interview cycle was integrated into the e-SBI-HV design. Participants included 17 home visitors and 7 clients across three Healthy Families America programs in New Jersey. RESULTS Round 1 interviews yielded 7 themes: (1) characterizing HV clients who use substances; (2) challenges to addressing SU in HV; (3) best practices for addressing SU in HV; (4) home visitor training and experience; (5) barriers to treatment; (6) technology in HV; and (7) e-SBI-HV implementation challenges and benefits. In Round 2, 7 additional themes emerged: (1) potential client concerns; (2) home visitor positive feedback; (3) feedback on home visitor component; (4) feedback on specific e-SBI components; (5) additional information to include; (6) integration of e-SBI into routine HV; and (7) needs to be met in the future. The user-centered design process yielded a prototype of the e-SBI-HV, including two e-SBI sessions and home visitor facilitation protocols. CONCLUSIONS This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Findings of the interviews indicate the complexity of addressing SU in the HV context, and directly informed the content and structure of the e-SBI-HV. Despite noted challenges, home visitors and clients generally reacted favorably to the e-SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, e-SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding overburdening home visitors. The next step in this research is to test the feasibility and preliminary efficacy of the e-SBI-HV. CLINICALTRIAL ClinicalTrials.gov NCT03750487
BACKGROUND Risky drinking (RD) is prevalent among women of childbearing age. While many women reduce their drinking during pregnancy, more than half return to pre-pregnancy levels during the early postpartum period. RD in new mothers may be associated with negative child and maternal health outcomes, however new mothers are unlikely to seek treatment for RD due to stigma and fear of child protective services involvement. Text messaging is a promising approach for reaching non-treatment-seeking new mothers at risk due to RD. Text messaging interventions are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time-adaptive text messaging intervention for postpartum RD. OBJECTIVE The objectives of this paper are to (1) present a preliminary conceptual model of postpartum RD, and (2) describe the protocol for conducting an ecological momentary assessment study with new mothers to inform refinement of the conceptual model and development of the text messaging intervention. METHODS The paper presents a preliminary conceptual model of postpartum RD, based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants, recruited via social media and New Jersey’s perinatal central intake system. Following baseline assessment, EMA surveys will be sent 5 times per day for 14 days. Assessment instruments and data analysis procedures are described. RESULTS Recruitment is scheduled to begin in January 2022, and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. CONCLUSIONS Study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for RD during the early postpartum period. Findings will be used to refine the conceptual model and inform the development of the text messaging intervention. Next steps for this work include development of intervention components via an iterative participatory design process, and testing of the resulting intervention in a pilot micro-randomized trial. CLINICALTRIAL ClinicalTrials.gov NCT04719390
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