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

基于艺术的干预措施解决临床医生耻辱并改善新生儿阿片类药物戒断综合症护理的可行性

基本信息

批准号：
10598068
负责人：
Clayton John Shuman
金额：
$ 23.4万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2025-03-31
项目状态：
未结题

项目摘要

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.

项目摘要对患有阿片类药物使用历史的母亲的临床医生污名会对循证护理的实施产生不利影响随后，婴儿的结果。我们的初步研究发现，有54.5％的围产期护士受到了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。这是因为每15分钟一次在美国，阿片类药物戒断的新生患者，围产期阿片类药物的使用率正在稳步上升。改善接触阿片类药物的母亲和婴儿的临床护理和结果被认为是顶级临床和公共卫生优先事项。许多研究建议围产期护士参与和支持母亲患有阿片类药物使用障碍以提供干预措施（母乳喂养，皮肤至皮肤护理，室友），可以改善短期和长期婴儿健康结果（例如，戒断症状严重程度，住院时间）。但是，这些努力的实施受到护士的困扰与围产期阿片类药物使用有关的污名参与者。通过解决污名化来改善婴儿健康的目标 Pi Shuman的态度开发了DAB-RN（用于注册护士的药物，艺术和婴儿），这是一种基于艺术的干预措施由科里根（Corrigan）的污名模式和同情的解放理论所告知。艺术长期以来一直被用来促进态度的变化和动机行为改变以及DAB-RN应用艺术品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改进了自我报告的与会者对围产期阿片类药物的使用，所有参与者都对干预措施表示很高的满意。后进行了两个焦点小组，我们发现干预措施受到当前交付格式的严重限制 - 由主持人领导的同步，团体交付的计划 - 必须适应更可扩展，可持续和可测试的计划平台。我们使用Adapt-Itt 8相模型来适应DAB-RN。我们在初步中完成了第1-3阶段工作。对于此R21提案，我们将完成4-8阶段。我们将解决我们初步中指出的障碍和关注点通过将DAB-RN适应基于Web的干预措施来进行测试，以进行异步，远程交付。然后，我们将剧院测试有24位护士和4位主题专家的潜水员样本，征求与会者的征集和反馈有关外观，流动，可用性，和干预的内容。调查结果将用于修改DAB-RN干预措施（AIM 1）。然后我们将测试在试点群集群集随机试验中，与两个臂的随机试验的可行性：1）实验组接受适应的DAB-RN干预（n = 75）和2）对照组未接受任何干预措施（n = 75）（AIM 2）。从实验组中，我们将检查可行性，包括可接受性，适应性，实用性，研究后勤（招聘，保留）和成本（生产，现场维护）。我们将对护士进行10次深入的访谈实验组，以更全面地评估可行性。我们将在基线和干预后的3个月以确定干预效果的方向，以告知将来的大型群集随机控制DAB-RN效率的控制试验。拟议的研究非常重要，并且非常适合NIH的优先事项，包括解决母校发病率（改善的倡议）和物质使用（Heal Initiative）。这项研究将导致可扩展 DAB-RN的版本用于一系列大规模研究，以评估有效性和有效性。