A digital intervention to decrease self-stigma among pregnant and postpartum women with opioid use disorder

项目摘要 阿片类药物的流行造成了广泛的、有害的公共健康后果和不成比例的 影响脆弱、高危群体，包括孕妇和产后妇女(PPW)及其婴儿。PPW 也面临着高度的自我污名--对自己负面情绪的内化，因为 滥用药物。自我羞辱与许多有害后果高度相关，包括康复。 结果和减少对药物使用治疗的参与。此外，自我羞辱阻碍了治疗 在PPW与OUD之间的启动和接触，导致对两者的额外不利健康后果 母亲和孩子。数字干预有可能支持PPW中更健康的行为 也可能提供一种很有希望的方法来减少他们的自我污名。Enearten是一种数字 干预措施，旨在促进在以下情况下坚持使用药物治疗和治疗保留 考虑到PPW的独特需求，但它目前缺乏减少自我污名的功能。在这份提案中， 我们将通过以污名为中心的生态瞬时干预(EMI)来增强Enearten，旨在：1) 筛选耻辱感和2)通过及时的干预来抵消这些脆弱性。具体来说， 在第一阶段，我们将调整Enearten以包括新的EMI功能，并使用Discover改进此工具， 设计/构建和测试(DDBT)框架，以确保它将减少易受攻击的人的自我污名 关键时刻的人口数量。在第二阶段开始时，我们将进行额外的DDBT周期，以 进一步提高我们的EMI的可用性和有效性。然后，我们将进行个人层面的多中心 用随机对照试验检验安心通降低自尊的可行性、可接受性和有效性 污名和改善治疗依从性。招募将在全国各地的不同诊所进行 专门用OUD治疗PPW的中西部医院。Enearten将成为使用OUD BY的PPW的无价工具 补充传统的面对面护理，减少自我羞辱，支持持续的激励和 在他们的康复过程中坚持他们的治疗计划。

Project Summary The opioid epidemic has resulted in widespread, detrimental public health consequences and disproportionally impacts vulnerable, high-risk groups including pregnant and postpartum women (PPW) and their babies. PPW with OUD also face high levels of self-stigma – the internalization of negative feelings about oneself because of drug misuse. Self-stigma is highly correlated with numerous detrimental consequences including recovery outcomes and reduced engagement with substance use treatment. Furthermore, self-stigma prevents treatment initiation and engagement among PPW with OUD, leading to additional adverse health outcomes for both mother and baby. Digital interventions have the potential to support healthier behaviors among PPW with OUD and may also provide a promising method for reducing their self-stigma. Enhearten is a digital intervention that is designed to foster adherence to medication for OUD and treatment retention while considering the unique needs of PPW, but it currently lacks features to decrease self-stigma. In this proposal, we will augment Enhearten with a stigma-focused ecological momentary intervention (EMI) designed to: 1) screen for feelings of stigma and 2) counteract these vulnerabilities via just-in-time interventions. Specifically, in Phase I, we will adapt Enhearten to include a new EMI feature and refine this tool using the Discover, Design/Build, and Test (DDBT) Framework to ensure that it will reduce self-stigma among this vulnerable population during critical moments. At the start of Phase II we will conduct an additional DDBT cycle to further increase the usability and efficacy of our EMI. Then, we will conduct an individual-level multicenter randomized controlled trial to test the feasibility, acceptability, and efficacy of Enhearten on reducing self- stigma and improving treatment adherence. Recruitment will occur from various clinics throughout the Midwest that specialize in treating PPW with OUD. Enhearten will be an invaluable tool for PPW with OUD by supplementing traditional in-person care, reducing self-stigma, and supporting continued motivation and adherence to their treatment plan during their recovery journey.