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

项目摘要 临床医生对有阿片类药物使用史的母亲的污名对循证护理的实施产生不利影响， 其次是婴儿的结局。初步调查发现，54.5%的围产护士存在较高的污名化 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。这是令人担忧的，因为每15分钟 在美国，新生儿患有阿片样物质戒断，并且围产期阿片样物质使用率稳步增加。 改善阿片类药物暴露的母亲和婴儿的临床护理和结果被认为是最重要的临床和公共卫生 要务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、皮肤对皮肤护理、母婴同室）（例如， 戒断症状严重程度、住院时间）。然而，这些努力的实施受到护士的阻碍， 与围产期阿片类药物使用有关的污名化态度。通过解决污名化问题实现改善婴儿健康的目标 PI Shuman开发了DAB-RN（注册护士的药物，艺术和婴儿），一种基于艺术的干预措施 由科里根的污名模型和同情解放理论提供信息。艺术长期以来被用来促进 态度改变和激励行为改变，DAB-RN应用艺术和艺术教学法来改善态度 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 通过两个焦点小组的讨论，我们发现干预措施受到其目前交付形式的严重限制- a 同步的，由主持人领导的小组交付的计划-并且必须适应更可扩展，可持续和可测试的 平台我们使用ADAPT-ITT 8阶段模型来适应DAB-RN。我们已经完成了初步的第1-3阶段， 工作对于这个R21提案，我们将完成第4-8阶段。我们将解决我们初步报告中提到的障碍和关切， 通过将DAB-RN调整为基于Web的异步远程交付干预来进行测试。然后，我们将进行戏剧测试， 程序与24名护士和4名主题专家的不同样本，征求对外观，流程，可用性， 干预的内容。研究结果将用于修改DAB-RN干预（目标1）。然后我们将测试 适应性DAB-RN干预的可行性在一项试点随机分组试验中，分为两组：1）实验组 接受适应的DAB-RN干预（N=75）和2）不接受任何干预的对照组（N=75）（目的2）。 从实验组出发，考察其可行性，包括可接受性、适应性、实用性、学习后勤 （招聘，保留）和成本（生产，网站维护）。我们将对10名护士进行深入访谈， 实验臂，以更全面地评估可行性。我们将在基线时测量护士的污名化态度， 3-在干预后的几个月内，确定干预效果的方向，以告知未来的大型随机分组 评价DAB-RN疗效的对照试验。拟议的研究意义重大，符合NIH的优先事项，包括 解决孕产妇发病率问题（IMPROVE倡议）和药物使用问题（HEAL倡议）。这项研究将导致一个可扩展的 DAB-RN的一个版本，为一系列评估疗效和有效性的大规模研究做好了准备。

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.