A digital intervention to decrease self-stigma among pregnant and postpartum women with opioid use disorder

项目摘要 阿片类药物的流行导致了广泛的，有害的公共卫生后果， 影响脆弱的高危群体，包括孕妇和产后妇女及其婴儿。PPW OUD患者也面临着高水平的自我耻辱--由于 滥用药物自我污名与包括康复在内的许多有害后果高度相关 结果并减少对药物使用治疗的参与。此外，自我污名阻碍了治疗 PPW与OUD之间的启动和参与，导致两者的额外不良健康结果 母亲和婴儿。数字干预有可能支持PPW中更健康的行为， OUD，也可能提供一个有前途的方法，减少他们的自我耻辱。Enhearten是一个数字 旨在促进OUD药物依从性和治疗保留的干预， 考虑到PPW的独特需求，但它目前缺乏减少自我污名的功能。在这一提议中， 我们将通过一项以污名为重点的生态瞬时干预（EMI）来加强Enhearten，该干预旨在：1） 筛查耻辱感，2）通过及时干预消除这些脆弱性。具体地说， 在第一阶段，我们将调整Enhearten，使其包含一个新的EMI功能，并使用Discover， 设计/建造和测试（DDBT）框架，以确保它将减少这一弱势群体的自我羞辱 关键时刻的人口。在第二阶段开始时，我们将进行额外的DDBT周期， 进一步提高EMI的可用性和功效。然后，我们将进行一项个人水平的多中心 一项随机对照试验，旨在测试Enhearten在减少自我 污名化和提高治疗依从性。招募将在整个 中西部，专门处理PPW与OUD。Enhearten将是PPW与OUD的宝贵工具， 补充传统的亲自护理，减少自我羞辱，并支持持续的动力， 在康复过程中坚持治疗计划。

Project Summary The opioid epidemic has resulted in widespread, detrimental public health consequences and disproportionally impacts vulnerable, high-risk groups including pregnant and postpartum women (PPW) and their babies. PPW with OUD also face high levels of self-stigma – the internalization of negative feelings about oneself because of drug misuse. Self-stigma is highly correlated with numerous detrimental consequences including recovery outcomes and reduced engagement with substance use treatment. Furthermore, self-stigma prevents treatment initiation and engagement among PPW with OUD, leading to additional adverse health outcomes for both mother and baby. Digital interventions have the potential to support healthier behaviors among PPW with OUD and may also provide a promising method for reducing their self-stigma. Enhearten is a digital intervention that is designed to foster adherence to medication for OUD and treatment retention while considering the unique needs of PPW, but it currently lacks features to decrease self-stigma. In this proposal, we will augment Enhearten with a stigma-focused ecological momentary intervention (EMI) designed to: 1) screen for feelings of stigma and 2) counteract these vulnerabilities via just-in-time interventions. Specifically, in Phase I, we will adapt Enhearten to include a new EMI feature and refine this tool using the Discover, Design/Build, and Test (DDBT) Framework to ensure that it will reduce self-stigma among this vulnerable population during critical moments. At the start of Phase II we will conduct an additional DDBT cycle to further increase the usability and efficacy of our EMI. Then, we will conduct an individual-level multicenter randomized controlled trial to test the feasibility, acceptability, and efficacy of Enhearten on reducing self- stigma and improving treatment adherence. Recruitment will occur from various clinics throughout the Midwest that specialize in treating PPW with OUD. Enhearten will be an invaluable tool for PPW with OUD by supplementing traditional in-person care, reducing self-stigma, and supporting continued motivation and adherence to their treatment plan during their recovery journey.