Mobile behavioral intervention to reduce maternal drinking in South Africa

项目摘要/摘要 该应用程序建议开发和测试基于技术的行为干预，以解决 南非孕妇饮酒情况(SA)。SA报告的人均饮酒率是#年最高的 并拥有世界上最高的被称为胎儿酒精谱系的终生疾病的比率 精神障碍(FASD)。产前饮酒通常与接触基于性别的暴力有关，而 由于新冠肺炎的不确定性和经济影响，基于性别的暴力增加是一个主要原因 担忧。最近的证据还表明，哺乳期间饮酒对儿童的健康有很大影响 通过母乳喂养接触酒精的儿童的发育和产后的不良影响 母乳喂养时饮酒与产前饮酒无关。平均母乳喂养 在SA中的持续时间超过1年，有和没有产前饮酒史的母亲中有40%以上 报告母乳喂养时饮酒的情况。以社区为基础的个案行为干预研究 管理有助于减少产前饮酒，但是劳动密集型的，挑战了 在经济困难社区广泛实施，特别是在新冠肺炎期间 社会接触有限的大流行。减少饮酒的有效行为干预 怀孕和哺乳需要发展在经济上可以接受和可行的 弱势社区，交通困难的妇女，或在新冠肺炎大流行期间 与有限的社交联系。拟议的干预措施将纳入移动呼气测定仪技术， 应急财政奖励、基于文本的健康促进和关于基于性别的暴力的转诊， 母婴健康和心理社会问题，包括在孕产妇保健背景下新冠肺炎的影响 酗酒。具体目标是(1)开发和预测基于技术的行为干预，以帮助 通过形成性定性研究，女性在怀孕和哺乳期间戒酒 有近期饮酒史、诊所和社区的怀孕或哺乳妇女 利益相关者，以及在南卡罗来纳州大都会角区成立的社区合作委员会，以及(2) 检查孕期和哺乳期饮酒干预措施的可接受性和可行性 对60名怀孕或产后的妇女进行了基于移动技术的平台的试点测试。 可接受性将在后续工作中进行评估，可行性将包括招聘能力、流程 措施和干预结果。具有可接受性和可行性的证据 为了确定干预的有效性，一项大规模的随机临床试验将变得至关重要。 可以远程合并所提议的行为干预的潜在设置包括主要 保健诊所、物质使用治疗方案和公共资助的孕产妇/婴儿方案 南非、美国和其他国家的人口。

PROJECT SUMMARY/ABSTRACT This application proposes to develop and test a technology-based behavioral intervention to address maternal alcohol use in South Africa (SA). SA reports the highest per capita rates of alcohol consumption in the world and has one of the world's highest rates of lifelong disorders called fetal alcohol spectrum disorders (FASD). Prenatal alcohol use is often associated with exposure to gender-based violence, and an increase in gender-based violence due to the uncertainty and economic impact of COVID-19 is of a major concern. Recent evidence also showed that alcohol use during lactation significantly compromises child development in children exposed to alcohol through breastfeeding, and the adverse effect of postpartum alcohol use while breastfeeding was independent of prenatal alcohol exposure. Average breastfeeding duration in SA is beyond 1 year, and over 40% of mothers with and without a history of prenatal drinking report alcohol use while breastfeeding. A community-based behavioral intervention involving case management helps reduce prenatal alcohol use but is labor intensive, challenging the feasibility of widespread implementation in economically disadvantaged communities especially during the COVID-19 pandemic with limited social contact. An efficacious behavioral intervention to reduce alcohol use during pregnancy and lactation needs to be developed that is acceptable and feasible in economically disadvantaged communities, for women with transportation difficulties, or during the COVID-19 pandemic with limited social contact. The proposed intervention will incorporate mobile breathalyzer technology, contingent financial incentives, and text-based health promotion and referrals on gender-based violence, maternal infant health, and psychosocial issues including the impact of COVID-19 in the context of maternal alcohol use. Specific aims are (1) to develop and pretest a technology-based behavioral intervention to help women abstain from alcohol use during pregnancy and lactation via formative qualitative research with women who are pregnant or breastfeeding with a recent history of alcohol use, clinic and community stakeholders, and an established Community Collaborative Board in Cape Metropole, SA, and (2) to examine the acceptability and feasibility of the intervention on alcohol use during pregnancy and lactation by pilot testing the mobile technology-based platform with 60 women who are pregnant or postpartum. Acceptability will be assessed at follow-ups, and feasibility will include recruitment capability, process measures, and intervention outcomes. With the evidence of acceptability and feasibility of the proposed intervention, a large randomized clinical trial will become essential to establish efficacy of the intervention. The potential settings that can remotely incorporate the proposed behavioral intervention include primary care clinics, substance use treatment programs, and publicly funded programs for maternal/infant populations in SA, the United States, and other countries.