Randomized Controlled Trial of Indigenous Recovery Planning for American Indians

美洲印第安人土著恢复计划的随机对照试验

基本信息

批准号：
10375589
负责人：
MONICA C SKEWES
金额：
$ 63.05万
依托单位：
MONTANA STATE UNIVERSITY - BOZEMAN
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10375589
关键词：
Abstinence Accidents Address Adult Affect Aftercare Alcohol consumption Alcohols American Indians Area Behavior Therapy Clinical Trials Communities Control Groups Data Distress Drug Use Disorder Employment Ensure Evidence based intervention Evidence based treatment Fetal Alcohol Spectrum Disorder Generations Grief reaction Health Health Services Accessibility Hypertension Indian reservation Indigenous Injury Institutional Racism Intervention Intervention Trial Interview Knowledge Lateral Liver diseases Maintenance Mediator of activation protein Medical Methods Montana Non-Insulin-Dependent Diabetes Mellitus Outcome Participant Persons Pharmaceutical Preparations Pilot Projects Population Public Health Quality of life Race Randomized Controlled Trials Recovery Reporting Research Research Project Grants Risk Factors Sioux Indians Spirituality Stress and Coping Structure Substance Use Disorder Suicide Testing Time Training Trauma Treatment outcome Universities Violence Waiting Lists Work barrier to care commune community based participatory research cultural values design disorder later incidence prevention effective therapy efficacious intervention efficacious treatment efficacy testing ethnic identity ethnic minority evidence base experience follow up assessment follow-up frontier healing health disparity health equity improved indexing innovation member mortality patient engagement post intervention preventive intervention primary outcome process evaluation prospective protective factors psychologic racism reduced substance use relapse risk satisfaction secondary outcome standard care substance use therapy design trauma symptom treatment effect tribal member

Abstinence Accidents Address Adult Affect Aftercare Alcohol consumption Alcohols American Indians Area Behavior Therapy Clinical Trials Communities Control Groups Data Distress Drug Use Disorder Employment Ensure Evidence based intervention Evidence based treatment Fetal Alcohol Spectrum Disorder Generations Grief reaction Health Health Services Accessibility Hypertension Indian reservation Indigenous Injury Institutional Racism Intervention Intervention Trial Interview Knowledge Lateral Liver diseases Maintenance Mediator of activation protein Medical Methods Montana Non-Insulin-Dependent Diabetes Mellitus Outcome Participant Persons Pharmaceutical Preparations Pilot Projects Population Public Health Quality of life Race Randomized Controlled Trials Recovery Reporting Research Research Project Grants Risk Factors Sioux Indians Spirituality Stress and Coping Structure Substance Use Disorder Suicide Testing Time Training Trauma Treatment outcome Universities Violence Waiting Lists Work barrier to care commune community based participatory research cultural values design disorder later incidence prevention effective therapy efficacious intervention efficacious treatment efficacy testing ethnic identity ethnic minority evidence base experience follow up assessment follow-up frontier healing health disparity health equity improved indexing innovation member mortality patient engagement post intervention preventive intervention primary outcome process evaluation prospective protective factors psychologic racism reduced substance use relapse risk satisfaction secondary outcome standard care substance use therapy design trauma symptom treatment effect tribal member

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项目摘要

Although there are high rates of abstinence among American Indians (AIs), there also is evidence of alcohol and drug use disorders disproportionately affecting Native communities. As a result of generations of systemic racism and historical trauma, AIs experience serious health disparities associated with substance use disorders (SUDs). Effective treatments for SUD are critically needed for improving health equity in AI communities, but there are few culturally grounded evidence-based interventions developed or tested with AIs. With this study, Randomized Controlled Trial of Indigenous Recovery Planning for American Indians, we aim to help fill this gap. Our research uses a Community-Based Participatory Research (CBPR) framework to test the efficacy of a culturally adapted relapse prevention intervention designed collaboratively by community partners from the Fort Peck Indian Reservation in northeastern Montana and research partners from Montana State University. Indigenous Recovery Planning (IRP) employs trained Fort Peck community members to deliver manualized intervention content culturally adapted from Relapse Prevention (RP), one of the most studied and efficacious treatments for SUD. Using data from 4 mixed-methods preliminary studies, we have worked closely with a Community Advisory Board (CAB) to modify RP to focus on strengths, increase levels of protective factors, address culturally specific risk factors, and overcome barriers to engagement in treatment. We now will test the efficacy of IRP in a prospective randomized controlled trial with 150 tribal members with SUD using a waitlist control group, a design desired by the community partners. Using random assignment to IRP (immediate intervention; n = 75) or to a waitlist control group (delayed intervention; n = 75), we will test the effects of IRP on primary outcomes (percent days abstinent) and secondary outcomes (substance-related consequences, quality of life) assessed post-intervention. We also will examine maintenance of changes in treatment outcomes at 12-week post-intervention follow-up, and examine hypothesized culturally specific mediators of treatment effects (AI identity, spirituality, communal mastery, grief and loss, distress from historical trauma, lateral violence, and racism) identified in our preliminary studies. Finally, we will conduct a process evaluation to examine the acceptability and sustainability of the intervention to ensure that IRP addresses barriers to evidence-based SUD interventions as designed. This research will fill an important gap in scientific knowledge regarding the efficacy and acceptability of culturally adapted evidence-based treatments tested in AI populations. This knowledge may be transferable to other communities with similar cultural values and barriers to treatment. By increasing access to efficacious treatment, this research has the potential to improve health outcomes and decrease SUD-related health disparities for underserved AI communities locally and nationally.

尽管美洲印第安人（AIS）的禁欲率很高，但也有饮酒的证据和药物使用障碍对本地社区的影响不成比例。由于几代人的系统性种族主义和历史创伤，AIS经历与药物使用相关的严重健康差异疾病（SUDS）。对SUD的有效治疗迫切需要改善人工智能健康公平社区，但使用AIS制定或测试的文化基于证据的干预措施很少。通过这项研究，美国印第安人的土著恢复计划的随机对照试验，我们的目标是帮助填补这一空白。我们的研究使用基于社区的参与研究（CBPR）框架来测试社区合作伙伴协作设计的文化改编的预防复发干预的功效从蒙大拿州东北部的佩克堡印度保留地和蒙大拿州的研究伙伴大学。土著恢复计划（IRP）雇用训练有素的佩克社区成员交付手动干预含量在文化上是根据预防复发（RP）改编的，这是研究最多的研究之一 SUD的有效治疗方法。使用来自4种混合方法的数据，我们已经密切合作使用社区咨询委员会（CAB）修改RP以专注于优势，提高保护性水平因素，解决文化特定的危险因素，并克服参与治疗的障碍。我们现在会的在一项前瞻性随机对照试验中测试IRP的功效，使用A的150个部落成员使用A WaitList Control Group，这是社区合作伙伴想要的设计。使用随机分配给IRP （立即干预； n = 75）或候补列表对照组（延迟干预； n = 75），我们将测试 IRP对主要结果（戒酒百分比）和次要结果（与物质有关的影响）的影响后果，生活质量）进行干预后评估。我们还将检查变更的维护干预后12周的治疗结果，并检查假设的文化特异性治疗效果的介体（人工智能身份，灵性，公共精通，悲伤和损失，痛苦在我们的初步研究中确定的历史创伤，横向暴力和种族主义）。最后，我们将进行过程评估以检查干预措施的可接受性和可持续性，以确保IRP 解决了设计的基于证据的SUD干预措施的障碍。这项研究将填补重要的空白关于文化适应循证治疗的疗效和可接受性的科学知识在AI人群中进行了测试。这些知识可能可以转移到具有相似文化价值的其他社区和治疗障碍。通过增加获得有效治疗的机会，这项研究有可能改善健康结果并减少在当地服务不足的AI社区的与SUD相关的健康差异在全国范围内。