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: 10709656
• 负责人: Patricia Anne Kinser
• 金额: $ 19.41万
• 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/10709656
• 关键词: Address; Adherence; Affect; Back; Behavior; Birth; Black race; Caring; Child; Communities; Complex; Consolidated Framework for Implementation Research; Data; Disparity; Education; Enrollment; Ensure; Equity; Evidence based treatment; Fetus; Funding; Future; Gestational Age; 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; Minority; Mothers; Motivation; Neonatal Abstinence Syndrome; Not Hispanic or Latino; Outcome; Overdose; Participant; Patient Care; 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; access disparities; care coordination; care delivery; community engagement; comparison group; cost; design; empowerment; ethnic disparity; experience; feasibility testing; fetal; group intervention; health disparity; health equity; health outcome disparity; high risk; improved outcome; innovation; insight; intervention cost; marginalization; marginalized population; maternal morbidity; maternal risk; mortality risk; multi-component intervention; neurobehavior; neurobehavioral; non-opioid analgesic; novel; obstetric outcomes; opioid use disorder; patient navigation; poor health outcome; pregnant; prenatal; programs; racial disparity; recruit; satisfaction; social health determinants; substance use; substance use treatment; success; systemic barrier; 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：有药物使用障碍（SUD）的孕妇经历了产前的重大障碍 护理和SUD治疗，对健康差异的NIH指定人群（HDPS;例如， 少数，低收入，农村）。经常服务不足和研究不足，有泡沫及其子女的妇女有 与使用女性的非固定性相比，与非HDP相比，健康结果不平等。 尽管存在有效的，基于循证的SUD治疗，但目前仅达到10-40％的孕妇 全国各地都有SUD，具有边缘化人群的多层结构和系统障碍。到 适当地解决了导致孕妇和儿童健康差异的复杂问题 在肥皂水的影响下，我们必须成功地通过消除障碍，赋予护理能力的妇女来吸引妇女， 并确保公平的治疗可用性和交付。这项初步研究汇集了 专业专业知识，新颖的工具和创新的护理交付方法，以探索潜在的低成本 可转换方法有可能改变具有高风险的个人的健康公平状态 母体发病率和死亡率（MMM）。胎儿超声成像已成为潜在的工具 促进精神上的联系，与增强产前护理和SUD治疗的参与有关。 研究设计：为了解决HDP泡沫孕妇的MMM，我们将测试多组分干预措施 涉及以前由我们团队测试的个人组件：实施的一种新颖的基于超声的协议 在社区中，通过20年的胎儿神经行为研究发展（Nexus：Neurobehavior， 参与，通过超声检查），与患者导航和护理协调结合。这 顺序挖掘的混合方法研究将测试可行性和可接受性（AIM 1）和初步 n = 60个孕妇，多支处理的Nexus干预的效果（AIM 2） 泡沫。我们将探索与实施相关的因素（目标3），以贡献未来大规模的关键数据 试验和翻译工作以评估这种方法是一种潜在的低成本，易于访问，可持续的方法 让妇女接受产前护理和SUD治疗。即使干预不成功，我们的 研究目的将提供足够的数据来确定最佳实践和替代策略。影响：医疗保健 是否有必要返回社区，因此该项目的高风险是一个方法，它具有方法 可以对可持续性进行缩放和修改。这项研究建立在经过验证的社区参与之上 该团队以前工作的策略，并试图解决与社会有关的贡献因素 健康的决定因素影响了这种高度边缘化的孕妇，这些孕妇经历了肥皂水。我们 与关键社区和州利益相关者建立了伙伴关系，以共同评估这些策略， 结果和可持续性计划。该程序计划的所有技术都可以轻松地转化为 孕妇的种群患有其他风险因素，包括心理健康状况。