Optimizing a Digital AEP Risk Intervention with Native Women and Communities

与原住民妇女和社区一起优化数字 AEP 风险干预

• 批准号: 10572200
• 负责人: Jessica D Hanson
• 金额: $ 26.84万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-20 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572200
• 关键词: Advertising; Alcohol consumption; Alcohols; Automation; Back; Behavior Therapy; Brain; Child; Code; Communities; Contraceptive methods; Counseling; Data; Devices; Dropout; Education; Equilibrium; Feasibility Studies; Fetal Alcohol Exposure; Fetal Alcohol Spectrum Disorder; Focus Groups; Frequencies; General Population; Goals; Great Plains; Heavy Drinking; High Risk Woman; Human; Inequity; Intellectual functioning disability; Intervention; Interview; Measures; Mediation; Methods; Native Americans; Navajo; Nervous System Trauma; Organ; Participant; Phase; Pregnancy; Pregnancy Tests; Pregnant Women; Randomized; Risk; Risk Behaviors; Risk Reduction; Safe Sex; Sampling; Seminal; Subgroup; Surveys; Testing; Text Messaging; Time; Tissues; Training; Treatment Efficacy; Tribes; Woman; Work; alcohol risk; automated text message; binge drinking; birth control; cost; design; digital; digital intervention; disability; drinking; evidence base; experimental study; follow-up; health literacy; high risk; high risk drinking; interest; life time cost; motivational enhancement therapy; multiphase optimization strategy; novel; outreach; physically handicapped; pilot test; pilot trial; pregnant; prevent; prototype; recruit; sexually active; skills; theories; timeline; tribal community; unintended pregnancy; working group

Over 3.3 million US women per month are at risk for Alcohol-Exposed Pregnancy (AEP). Prenatal alcohol exposure can cause lifetime costly intellectual and physical disabilities in children. Risk for AEP is greater among Native Americans, because rates of unintended pregnancy and binge/heavy drinking are inequitable between Native women and the general population. AEP counseling interventions for Native women are efficacious, but too costly to sustain. Digital interventions increase the reach of evidence-based behavioral interventions while reducing cost. This project will tailor and optimize the first digital AEP intervention, CARRII, piloted in a general population of women with AEP risk, for Native women. Guided by the Multiphase Optimization Strategy (MOST), we will systematically test a Native-tailored version of CARRII with candidate novel components to develop an optimized intervention for Native women at risk of AEP. The overarching goal of this R61/R33 proposal is to determine the optimal combination of novel intervention strategies to include with CARRII (tailored for Native women) that maximizes digital intervention efficacy at feasible cost for Native communities. In R61 Aim 1, we will identify needs for a digital intervention for AEP risk reduction for Native women, determine the best strategies for their engagement, evaluate and tailor CARRII intervention components for Native women, and deploy CARRII and new intervention components on a platform that is accessible on any device. In R61 Aim 2, we will tailor 5 new candidate intervention components that vary in automation and hypothesized impact on AEP risk behavior, and determine their costs and short-term effect sizes on alcohol and contraception. The 5 candidates are: repeated timeline follow-back AEP risk interviews, monthly pregnancy testing, digital training on skills for safer sex and reduced drinking, automated text messaging to prompt use of safer sex and reduced drinking skills, and access to an anonymized participant community message board. We will test each component in 6-week pre-post trials with 50 Native women to assess independent effects on drinking and contraception while considering practical aspects such as frequency and duration of contact with participants and costs of each component. Achieving R61 milestones will permit progression to the R33 phase. In R33 Aim 3, we will conduct a large 3-month factorial experiment with 512 participants. This design will identify the optimal intervention that efficiently balances AEP risk reduction with community-informed sustainable cost. We will conduct exploratory analyses of mediation/ moderation and identify study feasibility metrics (rates of Native women with AEP risk, and completing study recruitment, baseline, intervention, and follow-up vs. dropout) for a subsequent RCT. This project will be the first to systematically optimize a digital AEP intervention tailored for Native women at acceptable costs. The project will prepare the team for the first nationwide RCT of an optimized, sustainable digital AEP intervention tailored with and for Native women at risk of AEP to reduce AEPs in this high risk subpopulation.

每月有超过330万美国妇女有暴露于饮酒的风险（AEP）。产前酒精 暴露会导致终生昂贵的儿童智力和身体残疾。 AEP的风险更大 在美洲原住民中，因为意外怀孕和暴饮暴食的比率是不平等的 在本地妇女和普通人群之间。对本地妇女的AEP咨询干预措施是 有效的，但太昂贵了，无法维持。数字干预措施增加了基于证据的行为的影响 干预措施，同时降低成本。该项目将量身定制和优化第一个数字AEP干预措施Carrii， 对本地妇女的普通妇女驾驶。由多相引导 优化策略（大多数），我们将系统地测试与候选人 新的组成部分是为具有AEP风险的土著妇女开发优化的干预措施。总体目标 该R61/R33建议是确定新型干预策略的最佳组合，以包括 与Carrii（针对本地女性量身定制），以可行的成本最大化数字干预功效 社区。在R61 AIM 1中，我们将确定数字干预的需求，以减少本地的AEP风险 妇女，确定参与的最佳策略，评估和量身定制Carrii干预 土著妇女的组件，以及在平台上部署Carrii和新的干预组件 在任何设备上都可以访问。在R61 AIM 2中，我们将量身定制5种新的候选干预组件 自动化和假设对AEP风险行为的影响，并确定其成本和短期影响 酒精和避孕大小。这5个候选人是：重复时间表跟随AEP风险采访， 每月怀孕测试，关于更安全性和减少饮酒技能的数字培训，自动化文本 消息传递以提示使用更安全的性和降低的饮酒技巧，并访问匿名参与者 社区留言板。我们将与50名本地女性进行6周的前试验中的每个组件进行测试 评估对饮酒和避孕的独立影响，同时考虑实用方面 与参与者的接触频率和接触时间和每个组件的成本。实现R61里程碑 将允许发展为R33阶段。在R33 AIM 3中，我们将进行一个大型3个月阶乘实验 有512名参与者。该设计将确定有效平衡AEP风险的最佳干预措施 减少社区信息可持续成本。我们将进行调解/ 适度和确定研究可行性指标（具有AEP风险的土著妇女的速率和完成研究 随后的RCT招聘，基线，干预和随访与辍学）。这个项目将是 首先，以可接受的费用系统地优化针对本地女性量身定制的数字AEP干预措施。这 项目将使团队为优化，可持续的数字AEP干预措施的第一名全国RCT做好准备 在这种高风险亚人群中，量身定制的是有AEP风险的土著妇女。