Community-based fetal ultrasound and care navigation: An approach to engaging pregnant women with substance use disorder in prenatal care and substance use treatment

基于社区的胎儿超声和护理导航：一种让患有物质使用障碍的孕妇参与产前护理和物质使用治疗的方法

• 批准号: 10649029
• 负责人: Patricia Anne Kinser
• 金额: $ 22.57万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10649029
• 关键词: Address; Adherence; Affect; Back; Behavior; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Child; Communities; Complex; Consolidated Framework for Implementation Research; Data; Education; Enrollment; Ensure; Evidence based treatment; Fetus; Funding; Future; Gestational Age; Health; Health Services Accessibility; Healthcare; Hispanic; Image; Incidence; Individual; Infant; Intervention; Interview; Knowledge; Link; Low income; Maternal Mortality; Maternal and Child Health; Measures; Mental Health; Methods; Mothers; Motivation; Neonatal Abstinence Syndrome; Not Hispanic or Latino; Outcome; Overdose; Participant; Patients; Persons; Planning Techniques; Population; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Preparation; Protocols documentation; Psyche structure; Randomized; Randomized Controlled Trials; Reporting; Research; Research Design; Risk Factors; Rural; Self Management; Services; Standardization; Structure; Substance Use Disorder; Suicide; Testing; Time; Translations; Ultrasonography; Underserved Population; United States National Institutes of Health; Visit; Visual; Woman; Women' s Role; Work; acceptability and feasibility; base; care coordination; care delivery; community engagement; comparison group; cost; design; empowered; experience; feasibility testing; fetal; group intervention; health disparity; health equity; high risk; improved outcome; innovation; insight; intervention cost; marginalized population; maternal morbidity; maternal risk; mortality risk; multi-component intervention; neurobehavior; neurobehavioral; non-opioid analgesic; novel; obstetric outcomes; opioid use disorder; pregnant; prenatal; programs; racial and ethnic disparities; recruit; satisfaction; social health determinants; substance use; substance use treatment; success; tool; ultrasound

Project Summary Background: Pregnant women with substance use disorders (SUDs) experience significant barriers to prenatal care and SUD treatment, magnified for NIH-designated populations with health disparities (HDPs; e.g., minoritized, low-income, rural). Often underserved and under-studied, women with SUDs and their children have inequitable health outcomes compared to non-substance using women and compared to those from non-HDPs. Although effective, evidence-based treatments for SUDs exist, they currently reach only 10-40% of pregnant women with SUDs across the nation, with multi-level structural and systemic barriers for marginalized populations. To adequately address the complex issues leading to health disparities among pregnant women and children impacted by SUDs, we must be successful at engaging women by removing barriers, empowering care choices, and ensuring equitable treatment availability and delivery. This preliminary study brings together interprofessional expertise, novel tools, and innovative care delivery approaches to explore a potentially low-cost translatable approach with potential to transform the state of health equity among individuals at high risk for maternal morbidity and mortality (MMM). Fetal ultrasound imaging has emerged as a potential tool in the promotion of mental-fetal connection, linked to enhanced engagement in prenatal care and SUD treatment. Study Design: To address MMM in HDP pregnant women with SUDs we will test a multi- component intervention involving individual components previously tested by our team: a novel ultrasound-based protocol implemented in the community, developed through 20 years of fetal neurobehavioral research (NEXUS: Neurobehavior, Engagement, ConneXion through UltraSound), integrated with patient navigation and care coordination. This sequential explanatory mixed-methods study will test the feasibility and acceptability (Aim 1) and preliminary effects (Aim 2) of the multi-pronged NEXUS intervention, versus a comparator, in n=60 pregnant individuals with SUDs. We will explore factors related to implementation (Aim 3) to contribute key data for future larger-scale trials and translational work to evaluate this approach as a potentially low-cost, accessible, sustainable method for engaging women with prenatal care and SUD treatment. Even if the intervention is not successful, our research aims will provide ample data to determine best practices and alternative strategies. Impact: Health care is necessarily moving back into the community so the high risk of this project is a calculated one, with methods that can be scaled and modified for sustainability. This study is built upon proven community engagement strategies from this team’s previous work and attempts to address contributing factors related to social determinants of health affecting this highly marginalized population of pregnant women experiencing SUDs. We have developed partnerships with key community and state stakeholders to jointly evaluate the strategies, outcomes, and plans for sustainability. All of the techniques planned for this program are easily translatable to populations of pregnant persons with other risk factors including mental health conditions.

项目摘要 背景：患有物质使用障碍（SUD）的孕妇在产前检查中遇到重大障碍。 护理和SUD治疗，针对NIH指定的健康差异人群（HDP;例如， 少数民族、低收入、农村）。通常服务不足和研究不足，患有SUD的妇女及其子女 与不使用药物的妇女和非高血压患者相比，健康结果不公平。 尽管存在有效的、基于证据的SUD治疗方法，但目前只有10-40%的孕妇接受了治疗。 全国各地都有SUD，边缘化人群面临多层次的结构性和系统性障碍。到 充分解决导致孕妇和儿童健康差距的复杂问题 受SUD的影响，我们必须通过消除障碍，赋予护理选择权， 并确保公平的治疗提供和交付。这项初步研究汇集了 跨专业的专业知识，新颖的工具和创新的护理提供方法，以探索潜在的低成本 可翻译的方法，有可能改变高风险人群的健康公平状况， 产妇发病率和死亡率。胎儿超声成像已经成为一种潜在的工具， 促进精神与胎儿的联系，与加强产前护理和SUD治疗有关。 研究设计：为了解决患有SUD的HDP孕妇的MMM，我们将测试多组分干预 涉及我们团队先前测试过的单个组件：一种新的基于超声的协议 在社区，通过20年的胎儿神经行为研究（NEXUS：神经行为， Engagement、ConneXion通过UltraSound），与患者导航和护理协调相集成。这 顺序解释性混合方法研究将测试可行性和可接受性（目标1）和初步 在n=60例妊娠个体中，与对照药物相比，NEXUS多管齐下干预的效果（目的2） SUD。我们将探讨与实施（目标3）相关的因素，为未来更大规模的研究提供关键数据。 试验和转化工作，以评估这种方法作为一种潜在的低成本，可访问，可持续的方法 让妇女参与产前护理和SUD治疗。即使干预不成功， 研究目标将提供充足的数据，以确定最佳做法和替代战略。影响：保健 是必然要搬回社区，所以这个项目的高风险是一个计算，与方法 可以被扩展和修改以实现可持续性。这项研究是建立在证明社区参与 该团队以前的工作策略，并试图解决与社会相关的促成因素 影响这一经历SUD的高度边缘化孕妇群体的健康决定因素。我们 与主要社区和国家利益攸关方建立了伙伴关系，共同评估这些战略， 成果和可持续性计划。所有的技术计划为这个程序是很容易翻译成 有其他风险因素，包括精神健康状况的孕妇群体。