Feasibility of an Art-based Intervention to Address Clinician Stigma and Improve Care for Neonatal Opioid Withdrawal Syndrome

基于艺术的干预措施解决临床医生耻辱并改善新生儿阿片类药物戒断综合症护理的可行性

• 批准号: 10348928
• 负责人: Clayton John Shuman
• 金额: $ 19.5万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10348928
• 关键词: Address; Affect; Age-Years; Arts; Attitude; Behavior; Behavioral; Breast Feeding; COVID-19 pandemic; Caring; Cellular Phone; Clinical; Cluster randomized trial; Collaborations; Compassion; Complement; Control Groups; Data; Education; Ethnic Origin; Exhibits; Failure; Feedback; Focus Groups; Future; Goals; Helping to End Addiction Long-term; Hospitalization; Hospitals; Illinois; Infant; Infant Care; Infant Health; Intervention; Interview; Knowledge; Length; Logistics; Maintenance; Measures; Methods; Michigan; Midwestern United States; Minnesota; Modeling; Mothers; Neonatal Abstinence Syndrome; Newborn Infant; Nurses; Nursing Students; Ohio; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Perinatal; Perinatal Care; Perinatal Nursing; Pharmaceutical Preparations; Phase; Physicians; Production; Provider; Race; Randomized; Randomized Controlled Trials; Recording of previous events; Registered nurse; Reporting; Research; Sampling; Series; Severities; Site; Skin; Skin Care; Social Workers; Stigmatization; Tablets; Testing; Time; Training; United States; United States National Institutes of Health; Withdrawal Symptom; Woman; Work; Writing; arm; base; behavior change; care delivery; care outcomes; clinical care; clinical practice; cost; digital; drug withdrawal; effective intervention; effectiveness evaluation; efficacy evaluation; efficacy trial; evidence base; experience; experimental arm; experimental group; feasibility testing; improved; infant outcome; intervention effect; maternal morbidity; member; motivated behavior; neonatal care; opioid epidemic; opioid exposure; opioid use; opioid use disorder; opioid withdrawal; pedagogy; post intervention; programs; provider behavior; public health priorities; recruit; remote delivery; satisfaction; social stigma; substance use; theories; therapy design; usability; web site; web-based intervention

Project Summary Clinician stigma toward mothers with opioid use histories adversely affects implementation of evidence-based care and, subsequently, infant outcomes. Our preliminary research found 54.5% of perinatal nurses had heightened stigmatizing attitudes toward perinatal opioid use and neonatal opioid withdrawal syndrome. This is concerning because every 15 minutes a newborn suffers from opioid withdrawal in the United States and the rate of perinatal opioid use is steadily increasing. Improving clinical care and outcomes for opioid-exposed mothers and infants is considered a top clinical and public health priority. Numerous studies recommend perinatal nurses engage and support mothers with opioid use disorders to deliver interventions (breastfeeding, skin-to-skin care, rooming-in) that improve short and long-term infant health outcomes (eg, withdrawal symptom severity, length of hospitalization). However, the implementation of these efforts is stymied by nurse stigmatizing attitudes related to perinatal opioid use. Toward the goal of improving infant health by addressing stigmatizing attitudes, PI Shuman developed DAB-RN (Drugs, Art, and Babies for Registered Nurses), an art-based intervention informed by Corrigan’s model of stigma and the Emancipatory Theory of Compassion. Art has long been used to facilitate attitudinal change and motivate behavioral change and DAB-RN applies artwork and art pedagogy to improve attitudes about perinatal opioid use and, thus improve infant care and health outcomes. In our preliminary testing, DAB-RN improved self-reported attitudes toward perinatal opioid use and all participants reported high satisfaction with the intervention. After conducting two focus groups, we found that the intervention is severely limited by its current delivery format – a synchronous, group-delivered program led by a facilitator – and must be adapted to a more scalable, sustainable, and testable platform. We use the ADAPT-ITT 8-phase model to adapt DAB-RN. We have completed phases 1-3 in our preliminary work. For this R21 proposal, we will complete phases 4-8. We will address barriers and concerns noted in our preliminary testing by adapting DAB-RN to a web-based intervention for asynchronous, remote delivery. Then, we will theater test the program with a diverse sample of 24 nurses and 4 topic experts, soliciting attitudes and feedback on the look, flow, usability, and content of the intervention. Findings will be used to modify the DAB-RN intervention (Aim 1). Then we will test the feasibility of the adapted DAB-RN intervention in a pilot cluster randomized trial with two arms: 1) experimental group receiving the adapted DAB-RN intervention (N=75) and 2) control group not receiving any intervention (N=75) (Aim 2). From the experimental group, we will examine feasibility including acceptability, adaptation, practicality, study logistics (recruitment, retention), and cost (production, site maintenance). We will conduct 10 in-depth interviews with nurses in the experimental arm to more comprehensively assess feasibility. We will measure nurse stigmatizing attitudes at baseline and 3-months following the intervention to identify direction of intervention effects to inform a future large cluster randomized control trial evaluating DAB-RN’s efficacy. The proposed research is significant and fits well with NIH priorities, including addressing maternal morbidity (IMPROVE Initiative) and substance use (HEAL Initiative). This study will lead to a scalable version of DAB-RN primed for a series of large-scale studies evaluating efficacy and effectiveness.

项目概要 临床医生对有阿片类药物使用史的母亲的耻辱会对循证护理的实施产生不利影响， 随后，婴儿的结局。我们的初步研究发现，54.5% 的围产期护士有严重的耻辱感 对围产期阿片类药物使用和新生儿阿片类药物戒断综合征的态度。这很令人担忧，因为每 15 分钟 在美国，一名新生儿患有阿片类药物戒断，并且围产期阿片类药物使用率正在稳步上升。 改善阿片类药物暴露母亲和婴儿的临床护理和结果被认为是临床和公共卫生的首要任务 优先事项。许多研究建议围产期护士参与并支持患有阿片类药物使用障碍的母亲分娩 改善短期和长期婴儿健康结果的干预措施（母乳喂养、肌肤接触护理、同室）（例如， 戒断症状的严重程度、住院时间）。然而，这些努力的实施却受到护士的阻碍。 与围产期阿片类药物使用相关的污名化态度。通过解决污名化问题来实现改善婴儿健康的目标 为了改变人们的态度，PI S human 开发了 DAB-RN（注册护士的药物、艺术和婴儿），这是一种基于艺术的干预措施 受到科里根的耻辱模型和同情解放理论的启发。艺术长期以来一直被用来促进 态度改变并激励行为改变，DAB-RN 应用艺术品和艺术教育学来改善态度 关于围产期阿片类药物的使用，从而改善婴儿护理和健康结果。在我们的初步测试中，DAB-RN 改进了 自我报告对围产期阿片类药物使用的态度，所有参与者都对干预措施表示高度满意。后 通过两次焦点小组讨论，我们发现干预措施受到当前交付形式的严重限制—— 由协调员领导的同步、小组交付的程序，并且必须适应更具可扩展性、可持续性和可测试性 平台。我们使用 ADAPT-ITT 8 相模型来适配 DAB-RN。我们已经完成了初步阶段 1-3 工作。对于这个 R21 提案，我们将完成第 4-8 阶段。我们将解决初步报告中指出的障碍和担忧 通过使 DAB-RN 适应基于网络的异步远程交付干预来进行测试。然后，我们将进行剧院测试 该计划由 24 名护士和 4 名主题专家组成的不同样本组成，征求有关外观、流程、可用性、 以及干预的内容。研究结果将用于修改 DAB-RN 干预措施（目标 1）。然后我们将测试 改编后的 DAB-RN 干预在具有两个组的试点集群随机试验中的可行性：1）实验组 接受适应的 DAB-RN 干预 (N=75) 和 2) 对照组不接受任何干预 (N=75)（目标 2）。 从实验组中，我们将审查可行性，包括可接受性、适应性、实用性、学习逻辑 （招聘、保留）和成本（生产、现场维护）。我们将对护士进行10次深度访谈 实验臂更全面地评估可行性。我们将在基线和 干预后 3 个月确定干预效果的方向，为未来的大型集群随机化提供信息 评估 DAB-RN 功效的对照试验。拟议的研究意义重大，并且非常符合 NIH 的优先事项，包括 解决孕产妇发病率（IMPROVE 倡议）和药物滥用（HEAL 倡议）。这项研究将导致可扩展的 DAB-RN 版本准备用于评估功效和效果的一系列大规模研究。