Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study (Preprint)

Abstract

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