Mobile behavioral intervention to reduce maternal drinking in South Africa

移动行为干预减少南非孕产妇饮酒

• 批准号: 10165116
• 负责人: Yukiko Washio
• 金额: $ 21.95万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-05 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165116
• 关键词: Abstinence; Address; Adult; Adverse effects; Affect; African; Alcohol abuse; Alcohol consumption; Alcoholism; Ankle; Behavior Therapy; Biochemical; Breast Feeding; COVID-19; COVID-19 pandemic; Case Management; Centers for Disease Control and Prevention (U.S.); Child; Child Development; Clinic; Collaborations; Communities; Country; Disease; Economically Deprived Population; Employment; Exposure to; Family; Fetal Alcohol Exposure; Fetal Alcohol Spectrum Disorder; Funding; Goals; Health Benefit; Health Promotion; Health Services; Incentives; Infant; Infant Development; Infant Health; Infant Health Services; Institutes; International; Intervention; Lactation; Maternal Health; Maternal and Child Health; Medical Research; Mental Health; Monitor; Mothers; Outcome; Persons; Population; Postpartum Period; Pregnancy; Prevention strategy; Primary Health Care; Process Measure; Psychosocial Influences; Public Health; Qualitative Research; Randomized Clinical Trials; Recording of previous events; Reporting; Research; Rewards; Severities; Social Work; South Africa; South African; Technology; Testing; Text; Time; Tobacco use; Transportation; Treatment Efficacy; Uncertainty; United States; Woman; World Health Organization; Wrist; acceptability and feasibility; alcohol abstinence; alcohol abuse therapy; alcohol availability; alcohol consumption during pregnancy; alcohol exposure; base; cocaine abuse in pregnancy; cognitive development; community setting; contingency management; disorder risk; drinking; economic impact; financial incentive; gender-based violence; health disparity; maternal alcohol use; mobile computing; news; physical conditioning; pregnant; prenatal; prevent; programs; recruit; reduced alcohol use; remote intervention; remote monitoring; response; social; societal costs; substance use; substance use treatment; treatment program; wearable device

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.

项目概要/摘要 该应用程序建议开发和测试基于技术的行为干预来解决 南非 (SA) 的孕产妇饮酒情况。南澳报告人均酒精消费率最高 世界上患有胎儿酒精谱系疾病的终身疾病发生率最高的国家之一 疾病（FASD）。产前饮酒通常与遭受性别暴力有关，并且 由于 COVID-19 的不确定性和经济影响，基于性别的暴力增加是一个重大原因 忧虑。最近的证据还表明，哺乳期间饮酒会严重损害孩子的健康 通过母乳喂养接触酒精的儿童的发育以及产后的不利影响 母乳喂养期间的饮酒与产前酒精暴露无关。平均母乳喂养 SA持续时间超过1年，超过40%的母亲有或没有产前饮酒史 报告母乳喂养期间的饮酒情况。基于社区的行为干预案例 管理有助于减少产前饮酒，但属于劳动密集型，对可行性提出了挑战 在经济弱势社区广泛实施，特别是在 COVID-19 期间 社会接触有限的流行病。减少饮酒期间的有效行为干预 妊娠和哺乳期需要制定在经济上可接受且可行的方案 弱势社区、交通困难的妇女或在 COVID-19 大流行期间 社交接触有限。拟议的干预措施将结合移动呼吸分析仪技术， 或有的经济激励措施、基于文本的健康促进和针对性别暴力的转介， 孕产妇婴儿健康和心理社会问题，包括 COVID-19 对孕产妇的影响 酒精的使用。具体目标是 (1) 开发并预测试基于技术的行为干预措施，以帮助 通过形成性定性研究，妇女在怀孕和哺乳期间戒酒 近期有饮酒史、诊所和社区的怀孕或哺乳期妇女 利益相关者，以及在南澳州开普梅特波尔成立的社区合作委员会，以及 (2) 通过以下方式检查妊娠期和哺乳期饮酒干预措施的可接受性和可行性： 对 60 名孕妇或产后妇女对基于移动技术的平台进行了试点测试。 后续评估可接受性，可行性包括招聘能力、流程 措施和干预结果。具有所提议的可接受性和可行性的证据 干预措施后，大型随机临床试验对于确定干预措施的有效性至关重要。 可以远程纳入拟议的行为干预的潜在设置包括主要 护理诊所、药物滥用治疗计划以及公共资助的孕产妇/婴儿计划 南澳、美国和其他国家的人口。