Mobile behavioral intervention to reduce maternal drinking in South Africa

移动行为干预减少南非孕产妇饮酒

• 批准号: 10165116
• 负责人: Yukiko Washio
• 金额: $ 21.95万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-05 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165116
• 关键词: Abstinence; Address; Adult; Adverse effects; Affect; African; Alcohol abuse; Alcohol consumption; Alcoholism; Ankle; Behavior Therapy; Biochemical; Breast Feeding; COVID-19; COVID-19 pandemic; Case Management; Centers for Disease Control and Prevention (U.S.); Child; Child Development; Clinic; Collaborations; Communities; Country; Disease; Economically Deprived Population; Employment; Exposure to; Family; Fetal Alcohol Exposure; Fetal Alcohol Spectrum Disorder; Funding; Goals; Health Benefit; Health Promotion; Health Services; Incentives; Infant; Infant Development; Infant Health; Infant Health Services; Institutes; International; Intervention; Lactation; Maternal Health; Maternal and Child Health; Medical Research; Mental Health; Monitor; Mothers; Outcome; Persons; Population; Postpartum Period; Pregnancy; Prevention strategy; Primary Health Care; Process Measure; Psychosocial Influences; Public Health; Qualitative Research; Randomized Clinical Trials; Recording of previous events; Reporting; Research; Rewards; Severities; Social Work; South Africa; South African; Technology; Testing; Text; Time; Tobacco use; Transportation; Treatment Efficacy; Uncertainty; United States; Woman; World Health Organization; Wrist; acceptability and feasibility; alcohol abstinence; alcohol abuse therapy; alcohol availability; alcohol consumption during pregnancy; alcohol exposure; base; cocaine abuse in pregnancy; cognitive development; community setting; contingency management; disorder risk; drinking; economic impact; financial incentive; gender-based violence; health disparity; maternal alcohol use; mobile computing; news; physical conditioning; pregnant; prenatal; prevent; programs; recruit; reduced alcohol use; remote intervention; remote monitoring; response; social; societal costs; substance use; substance use treatment; treatment program; wearable device

PROJECT SUMMARY/ABSTRACT This application proposes to develop and test a technology-based behavioral intervention to address maternal alcohol use in South Africa (SA). SA reports the highest per capita rates of alcohol consumption in the world and has one of the world's highest rates of lifelong disorders called fetal alcohol spectrum disorders (FASD). Prenatal alcohol use is often associated with exposure to gender-based violence, and an increase in gender-based violence due to the uncertainty and economic impact of COVID-19 is of a major concern. Recent evidence also showed that alcohol use during lactation significantly compromises child development in children exposed to alcohol through breastfeeding, and the adverse effect of postpartum alcohol use while breastfeeding was independent of prenatal alcohol exposure. Average breastfeeding duration in SA is beyond 1 year, and over 40% of mothers with and without a history of prenatal drinking report alcohol use while breastfeeding. A community-based behavioral intervention involving case management helps reduce prenatal alcohol use but is labor intensive, challenging the feasibility of widespread implementation in economically disadvantaged communities especially during the COVID-19 pandemic with limited social contact. An efficacious behavioral intervention to reduce alcohol use during pregnancy and lactation needs to be developed that is acceptable and feasible in economically disadvantaged communities, for women with transportation difficulties, or during the COVID-19 pandemic with limited social contact. The proposed intervention will incorporate mobile breathalyzer technology, contingent financial incentives, and text-based health promotion and referrals on gender-based violence, maternal infant health, and psychosocial issues including the impact of COVID-19 in the context of maternal alcohol use. Specific aims are (1) to develop and pretest a technology-based behavioral intervention to help women abstain from alcohol use during pregnancy and lactation via formative qualitative research with women who are pregnant or breastfeeding with a recent history of alcohol use, clinic and community stakeholders, and an established Community Collaborative Board in Cape Metropole, SA, and (2) to examine the acceptability and feasibility of the intervention on alcohol use during pregnancy and lactation by pilot testing the mobile technology-based platform with 60 women who are pregnant or postpartum. Acceptability will be assessed at follow-ups, and feasibility will include recruitment capability, process measures, and intervention outcomes. With the evidence of acceptability and feasibility of the proposed intervention, a large randomized clinical trial will become essential to establish efficacy of the intervention. The potential settings that can remotely incorporate the proposed behavioral intervention include primary care clinics, substance use treatment programs, and publicly funded programs for maternal/infant populations in SA, the United States, and other countries.

项目摘要/摘要 该申请建议开发和测试基于技术的行为干预措施以解决 南非的孕产妇使用（SA）。 SA报告人均饮酒率最高 世界，拥有世界上最高的终身疾病率之一，称为胎儿酒精谱 疾病（FASD）。产前饮酒通常与暴露于性别基于性别的暴力有关 由于COVID-19的不确定性和经济影响，基于性别的暴力增加是主要的 忧虑。最近的证据还表明，哺乳期间的饮酒会显着损害儿童 通过母乳喂养暴露于酒精的儿童的发育和产后的不利影响 母乳喂养时的饮酒独立于产前酒精暴露。平均母乳喂养 SA的持续时间超过1年，有40％的母亲有和没有饮酒史 报告母乳喂养时使用酒精。涉及案例的基于社区的行为干预 管理有助于减少产前饮酒，但富含劳动力，挑战 在经济不利的社区中，特别是在Covid-19期间，广泛实施 大流行，社会接触有限。有效的行为干预，以减少在 需要开发怀孕和泌乳，在经济上是可以接受且可行的 处境不利的社区，用于运输困难的妇女或在19日期间流行期间 社交接触有限。拟议的干预措施将结合移动呼吸分析仪技术， 或有经济激励措施，基于文本的健康促进和基于性别的暴力的推荐， 孕产妇的健康和社会心理问题，包括Covid-19在母亲中的影响 饮酒。具体目标是（1）开发和预测基于技术的行为干预措施以帮助 通过形成性定性研究，妇女在怀孕和哺乳期间不戒酒 怀孕或母乳喂养的妇女最近有酒精，诊所和社区的历史 利益相关者，以及SA开普大都会的既定社区合作委员会，以及（2） 检查怀孕期间对饮酒和哺乳期间饮酒干预的可接受性和可行性 试点测试基于移动技术的平台，有60名怀孕或产后的女性。 可接受性将在随访中进行评估，可行性将包括招聘能力，过程 措施和干预结果。有证据表明提议的可接受性和可行性 干预措施，一项大型随机临床试验对于确定干预效率至关重要。 可以远程纳入所提出的行为干预的潜在设置包括主要设置 护理诊所，药物使用治疗计划以及公共资助的母亲/婴儿计划 SA，美国和其他国家的人口。