Optimizing a Digital AEP Risk Intervention with Native Women and Communities

与原住民妇女和社区一起优化数字 AEP 风险干预

• 批准号: 10572200
• 负责人: Jessica D Hanson
• 金额: $ 26.84万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-20 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572200
• 关键词: Advertising; Alcohol consumption; Alcohols; Automation; Back; Behavior Therapy; Brain; Child; Code; Communities; Contraceptive methods; Counseling; Data; Devices; Dropout; Education; Equilibrium; Feasibility Studies; Fetal Alcohol Exposure; Fetal Alcohol Spectrum Disorder; Focus Groups; Frequencies; General Population; Goals; Great Plains; Heavy Drinking; High Risk Woman; Human; Inequity; Intellectual functioning disability; Intervention; Interview; Measures; Mediation; Methods; Native Americans; Navajo; Nervous System Trauma; Organ; Participant; Phase; Pregnancy; Pregnancy Tests; Pregnant Women; Randomized; Risk; Risk Behaviors; Risk Reduction; Safe Sex; Sampling; Seminal; Subgroup; Surveys; Testing; Text Messaging; Time; Tissues; Training; Treatment Efficacy; Tribes; Woman; Work; alcohol risk; automated text message; binge drinking; birth control; cost; design; digital; digital intervention; disability; drinking; evidence base; experimental study; follow-up; health literacy; high risk; high risk drinking; interest; life time cost; motivational enhancement therapy; multiphase optimization strategy; novel; outreach; physically handicapped; pilot test; pilot trial; pregnant; prevent; prototype; recruit; sexually active; skills; theories; timeline; tribal community; unintended pregnancy; working group

Over 3.3 million US women per month are at risk for Alcohol-Exposed Pregnancy (AEP). Prenatal alcohol exposure can cause lifetime costly intellectual and physical disabilities in children. Risk for AEP is greater among Native Americans, because rates of unintended pregnancy and binge/heavy drinking are inequitable between Native women and the general population. AEP counseling interventions for Native women are efficacious, but too costly to sustain. Digital interventions increase the reach of evidence-based behavioral interventions while reducing cost. This project will tailor and optimize the first digital AEP intervention, CARRII, piloted in a general population of women with AEP risk, for Native women. Guided by the Multiphase Optimization Strategy (MOST), we will systematically test a Native-tailored version of CARRII with candidate novel components to develop an optimized intervention for Native women at risk of AEP. The overarching goal of this R61/R33 proposal is to determine the optimal combination of novel intervention strategies to include with CARRII (tailored for Native women) that maximizes digital intervention efficacy at feasible cost for Native communities. In R61 Aim 1, we will identify needs for a digital intervention for AEP risk reduction for Native women, determine the best strategies for their engagement, evaluate and tailor CARRII intervention components for Native women, and deploy CARRII and new intervention components on a platform that is accessible on any device. In R61 Aim 2, we will tailor 5 new candidate intervention components that vary in automation and hypothesized impact on AEP risk behavior, and determine their costs and short-term effect sizes on alcohol and contraception. The 5 candidates are: repeated timeline follow-back AEP risk interviews, monthly pregnancy testing, digital training on skills for safer sex and reduced drinking, automated text messaging to prompt use of safer sex and reduced drinking skills, and access to an anonymized participant community message board. We will test each component in 6-week pre-post trials with 50 Native women to assess independent effects on drinking and contraception while considering practical aspects such as frequency and duration of contact with participants and costs of each component. Achieving R61 milestones will permit progression to the R33 phase. In R33 Aim 3, we will conduct a large 3-month factorial experiment with 512 participants. This design will identify the optimal intervention that efficiently balances AEP risk reduction with community-informed sustainable cost. We will conduct exploratory analyses of mediation/ moderation and identify study feasibility metrics (rates of Native women with AEP risk, and completing study recruitment, baseline, intervention, and follow-up vs. dropout) for a subsequent RCT. This project will be the first to systematically optimize a digital AEP intervention tailored for Native women at acceptable costs. The project will prepare the team for the first nationwide RCT of an optimized, sustainable digital AEP intervention tailored with and for Native women at risk of AEP to reduce AEPs in this high risk subpopulation.

每月有超过330万美国女性面临酒精暴露妊娠（AEP）的风险。产前酒精 接触可导致儿童终身智力和身体残疾，代价高昂。AEP的风险更大 在美洲原住民中，因为意外怀孕和酗酒的比例是不公平的， 土著妇女和普通民众之间的关系土著妇女的AEP咨询干预措施是 有效，但成本太高，无法维持。数字干预增加了基于证据的行为 干预，同时降低成本。该项目将定制和优化第一个数字AEP干预，CARRII， 在有AEP风险的普通妇女人群中进行试点，针对土著妇女。以多阶段为导向 优化策略（MOST），我们将系统地测试CARRII的本地定制版本， 新的组成部分，为有AEP风险的土著妇女制定最佳干预措施。总体目标 这项R61/R33建议的目的是确定新干预策略的最佳组合， 与CARRII（为土著妇女量身定制），以可行的成本为土著妇女最大限度地提高数字干预效果 社区.在R61 Aim 1中，我们将确定数字干预的需求，以降低本地AEP风险 妇女，确定其参与的最佳战略，评估和调整CARRII干预措施 土著妇女的组成部分，并在一个平台上部署CARRII和新的干预组成部分， 可在任何设备上访问。在R61目标2中，我们将定制5个新的候选干预组件， 自动化和假设对AEP风险行为的影响，并决定其成本和短期效果 酒精和避孕的重要性这5个候选人是：重复的时间轴跟踪AEP风险访谈， 每月怀孕测试，关于安全性行为和减少饮酒技能的数字培训，自动文本 提示使用安全性行为和减少饮酒技能的信息，以及访问匿名参与者 社区留言板我们将在50名土著妇女中进行为期6周的前后试验， 评估对饮酒和避孕的独立影响，同时考虑实际方面， 与参与者联系的频率和持续时间以及每个部分的费用。实现R61里程碑 将允许进展到R33阶段。在R33目标3中，我们将进行一项为期3个月的大型析因实验 512名参与者该设计将确定有效平衡AEP风险的最佳干预措施 减少社区知情的可持续成本。我们将对调解进行探索性分析/ 适度和确定研究可行性指标（土著妇女的AEP风险率，并完成研究 招募、基线、干预和随访与脱落）。该项目将是 首先以可接受的成本系统地优化针对土著妇女的数字AEP干预。的 该项目将为第一个优化的，可持续的数字AEP干预的全国性RCT做好准备 为有AEP风险的土著妇女量身定制，以减少这一高风险亚群中的AEP。