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：
10574494
负责人：
MONICA C SKEWES
金额：
$ 63.07万
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/10574494
关键词：
Abstinence Accidents Address Adult Affect Aftercare Alcohols American Indians Area Behavior Therapy Clinical Trials Communities Control Groups Data Distress Drug Use Disorder Employment 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 Manuals Mediator Medical Methods Montana Non-Insulin-Dependent Diabetes Mellitus Outcome Outcome Assessment Participant Persons Pharmaceutical Preparations Pilot Projects Population Public Health Quality of life Race Random Allocation Randomized Randomized, Controlled Trials Recovery Reporting Research Research Project Grants Risk Factors Sioux Indians Spirituality Stress and Coping Structure Substance Use Disorder Suicide Testing Training Trauma Treatment outcome Universities Violence Waiting Lists Work alcohol use disorder barrier to care commune community based participatory research cultural values design 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 randomized, controlled study reduced substance use relapse prevention relapse risk satisfaction secondary outcome standard care substance use therapy design trauma symptom treatment effect tribal member

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 (AI) 的戒酒率很高，但也有证据表明他们酗酒和吸毒障碍对原住民社区造成不成比例的影响。由于几代系统的种族主义和历史创伤，人工智能经历了与药物使用相关的严重健康差异疾病（SUD）。为了改善人工智能的健康公平性，迫切需要针对 SUD 的有效治疗但很少有基于文化的循证干预措施是用人工智能开发或测试的。通过这项研究，即美洲印第安人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性研究（CBPR）框架来测试由社区合作伙伴合作设计的适应文化的复发预防干预措施的功效来自蒙大拿州东北部佩克堡印第安人保留地和来自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堡社区成员来交付手动干预内容在文化上改编自复发预防（RP），这是研究最多和最广泛的方法之一 SUD 的有效治疗方法。使用 4 项混合方法初步研究的数据，我们密切合作与社区咨询委员会 (CAB) 一起修改 RP，以专注于优势，提高保护水平因素，解决文化上特定的风险因素，并克服参与治疗的障碍。我们现在将在一项前瞻性随机对照试验中测试 IRP 的功效，该试验有 150 名患有 SUD 的部落成员，使用等候名单控制组，这是社区合作伙伴期望的设计。对 IRP 使用随机分配（立即干预；n = 75）或等待名单对照组（延迟干预；n = 75），我们将测试 IRP 对主要结果（禁欲天数百分比）和次要结果（物质相关）的影响后果、生活质量）在干预后进行评估。我们还将检查变更的维护干预后 12 周随访的治疗结果，并检查假设的文化特异性治疗效果的中介因素（人工智能身份、灵性、公共掌握、悲伤和失落、来自历史创伤、横向暴力和种族主义）是我们在初步研究中发现的。最后，我们将进行一次过程评估，以检查干预措施的可接受性和可持续性，以确保 IRP 解决设计的基于证据的 SUD 干预措施的障碍。这项研究将填补一项重要空白关于适应文化的循证治疗的功效和可接受性的科学知识在人工智能人群中进行了测试。这些知识可以转移到具有相似文化价值观的其他社区以及治疗的障碍。通过增加获得有效治疗的机会，这项研究有可能改善当地服务不足的人工智能社区的健康结果并减少与 SUD 相关的健康差异和全国范围内。