Community-based fetal ultrasound and care navigation: An approach to engaging pregnant women with substance use disorder in prenatal care and substance use treatment

基于社区的胎儿超声和护理导航：一种让患有物质使用障碍的孕妇参与产前护理和物质使用治疗的方法

• 批准号: 10709656
• 负责人: Patricia Anne Kinser
• 金额: $ 19.41万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10709656
• 关键词: Address; Adherence; Affect; Back; Behavior; Birth; Black race; Caring; Child; Communities; Complex; Consolidated Framework for Implementation Research; Data; Disparity; Education; Enrollment; Ensure; Equity; Evidence based treatment; Fetus; Funding; Future; Gestational Age; Health Services Accessibility; Healthcare; Hispanic; Image; Incidence; Individual; Infant; Intervention; Interview; Knowledge; Link; Low income; Maternal Mortality; Maternal and Child Health; Measures; Mental Health; Methods; Minority; Mothers; Motivation; Neonatal Abstinence Syndrome; Not Hispanic or Latino; Outcome; Overdose; Participant; Patient Care; Persons; Planning Techniques; Population; Postpartum Period; Pregnancy; Pregnant Women; Prenatal care; Preparation; Protocols documentation; Psyche structure; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Design; Risk Factors; Rural; Self Management; Services; Standardization; Structure; Substance Use Disorder; Suicide; Testing; Time; Translations; Ultrasonography; Underserved Population; United States National Institutes of Health; Visit; Visual; Woman; Women' s Role; Work; acceptability and feasibility; access disparities; care coordination; care delivery; community engagement; comparison group; cost; design; empowerment; ethnic disparity; experience; feasibility testing; fetal; group intervention; health disparity; health equity; health outcome disparity; high risk; improved outcome; innovation; insight; intervention cost; marginalization; marginalized population; maternal morbidity; maternal risk; mortality risk; multi-component intervention; neurobehavior; neurobehavioral; non-opioid analgesic; novel; obstetric outcomes; opioid use disorder; patient navigation; poor health outcome; pregnant; prenatal; programs; racial disparity; recruit; satisfaction; social health determinants; substance use; substance use treatment; success; systemic barrier; tool; ultrasound

Project Summary Background: Pregnant women with substance use disorders (SUDs) experience significant barriers to prenatal care and SUD treatment, magnified for NIH-designated populations with health disparities (HDPs; e.g., minoritized, low-income, rural). Often underserved and under-studied, women with SUDs and their children have inequitable health outcomes compared to non-substance using women and compared to those from non-HDPs. Although effective, evidence-based treatments for SUDs exist, they currently reach only 10-40% of pregnant women with SUDs across the nation, with multi-level structural and systemic barriers for marginalized populations. To adequately address the complex issues leading to health disparities among pregnant women and children impacted by SUDs, we must be successful at engaging women by removing barriers, empowering care choices, and ensuring equitable treatment availability and delivery. This preliminary study brings together interprofessional expertise, novel tools, and innovative care delivery approaches to explore a potentially low-cost translatable approach with potential to transform the state of health equity among individuals at high risk for maternal morbidity and mortality (MMM). Fetal ultrasound imaging has emerged as a potential tool in the promotion of mental-fetal connection, linked to enhanced engagement in prenatal care and SUD treatment. Study Design: To address MMM in HDP pregnant women with SUDs we will test a multi- component intervention involving individual components previously tested by our team: a novel ultrasound-based protocol implemented in the community, developed through 20 years of fetal neurobehavioral research (NEXUS: Neurobehavior, Engagement, ConneXion through UltraSound), integrated with patient navigation and care coordination. This sequential explanatory mixed-methods study will test the feasibility and acceptability (Aim 1) and preliminary effects (Aim 2) of the multi-pronged NEXUS intervention, versus a comparator, in n=60 pregnant individuals with SUDs. We will explore factors related to implementation (Aim 3) to contribute key data for future larger-scale trials and translational work to evaluate this approach as a potentially low-cost, accessible, sustainable method for engaging women with prenatal care and SUD treatment. Even if the intervention is not successful, our research aims will provide ample data to determine best practices and alternative strategies. Impact: Health care is necessarily moving back into the community so the high risk of this project is a calculated one, with methods that can be scaled and modified for sustainability. This study is built upon proven community engagement strategies from this team’s previous work and attempts to address contributing factors related to social determinants of health affecting this highly marginalized population of pregnant women experiencing SUDs. We have developed partnerships with key community and state stakeholders to jointly evaluate the strategies, outcomes, and plans for sustainability. All of the techniques planned for this program are easily translatable to populations of pregnant persons with other risk factors including mental health conditions.

项目概要 背景：患有物质使用障碍 (SUD) 的孕妇在产前经历重大障碍 护理和 SUD 治疗，针对 NIH 指定的健康差异人群（HDP；例如， 患有 SUD 的妇女及其子女往往得不到充分的服务和研究 与非物质使用女性和非 HDP 相比，健康结果不公平。 尽管存在针对 SUD 的有效且基于证据的治疗方法，但目前仅适用于 10-40% 的孕妇 与全国各地的 SUD 合作，为边缘化人群设置多层次的结构性和系统性障碍。 充分解决导致孕妇和儿童健康差异的复杂问题 受 SUD 的影响，我们必须通过消除障碍、赋予护理选择权、 这项初步研究汇集了治疗的可得性和提供的公平性。 跨专业的专业知识、新颖的工具和创新的护理提供方法，以探索潜在的低成本 可转化的方法有可能改变高危人群的健康公平状况 孕产妇发病率和死亡率（MMM）已成为胎儿超声成像的潜在工具。 促进心理与胎儿的联系，与加强产前护理和 SUD 治疗的参与有关。 研究设计：为了解决患有 SUD 的 HDP 孕妇的 MMM，我们将测试多成分干预措施 涉及我们团队之前测试过的各个组件：实施了一种新颖的基于超声波的协议 在社区中，通过 20 年的胎儿神经行为研究开发出来（NEXUS：Neurobehavior， 参与、通过超声波的 ConneXion），与患者导航和护理协调集成。 顺序解释性混合方法研究将测试可行性和可接受性（目标 1）和初步 多管齐下 NEXUS 干预措施与比较措施相比，在 n=60 名患有以下疾病的孕妇中的效果（目标 2） 我们将探索与实施（目标 3）相关的因素，为未来更大规模的贡献关键数据。 进行试验和转化工作，以评估这种方法作为一种潜在的低成本、易获得、可持续的方法 让妇女参与产前护理和 SUD 治疗 即使干预措施不成功，我们的 研究目标将提供样本数据以确定最佳实践和替代策略影响：医疗保健。 必然要回到社区，所以这个项目的高风险是经过计算的，有方法 这项研究是建立在经过验证的社区参与的基础上的。 该团队之前的工作策略以及解决与社会相关的影响因素的努力 影响患有 SUD 的高度边缘化孕妇群体的健康决定因素。 与主要社区和州利益相关者建立了伙伴关系，共同评估这些战略， 该计划计划的所有技术都可以轻松转化为成果和可持续性计划。 具有其他危险因素（包括精神健康问题）的孕妇群体。