(28) Project BETTER Acceptability: Technology-Based Educational Intervention for Women on MOUD

Introduction
People of child-bearing potential with opioid use disorder (OUD) face unique stressors during the transition from pregnancy to postpartum that can be challenging to recovery and increase overdose risk (1). Postpartum individuals with OUD report feeling underprepared to cope with the postpartum transition, care for infants with withdrawal symptoms and interact with child welfare (2). Evidence-based, person-centered, clinically feasible prenatal educational tools are needed to effectively equip the parent-infant dyad affected by OUD for continued recovery and optimal long-term outcomes (3). Tailored, technology-based educational interventions may fill this gap. The primary study objective is to report patient acceptability of a newly developed technology-based educational intervention for pregnant and parenting individuals receiving medication for OUD (MOUD). Secondarily, we describe a novel, comprehensive acceptability measure for technology-based interventions.

Methods
For the current study, people of childbearing potential are recruited from a perinatal addiction clinic research registry to pilot test technology-based intervention modules. All clinic patients are invited to participate in the registry. Patients who have consented to the registry, who are receiving MOUD, are pregnant or within 12 months postpartum, and have a history or current pregnancy receiving MOUD are eligible for this pilot study (target sample Nf12 by November 2021). Demographic and clinical characteristics are gathered from medical record review. Participants complete one of three modules (Postpartum Transition, Neonatal Opioid Withdrawal Syndrome, or Child Welfare Interactions) either in-person or virtually followed by a survey assessing acceptability. Acceptability is assessed by two items widely used in the field: “How much do you like using the module?” and “To what extent do you find the module easy to use?” (Likert scale range 1-5) (4). Additionally, a 23-item comprehensive acceptability measure designed specifically for technology-based interventions is being tested. The comprehensive acceptability measure aims to capture seven components (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy) of the theoretical framework of acceptability (TFA). Preliminary descriptive statistics were calculated for acceptability items. TFA component scores will be calculated upon recruitment completion.

Results
In these preliminary data, participants (n=7) were 85.7% White and middle-aged (mean 31±5 years). Most of the participants were postpartum (71.4%) while several were pregnant. All participants completed the module and survey virtually. Participants rated the modules as highly acceptable based on the acceptability items. Modules were rated as well liked [median=4 (IQR 3-5)] and easy to use [median=5 (IQR 5-5)]. Additional comprehensive acceptability items also scored well. Participants felt more comfortable learning from the technology-based modules than from their provider [median=5 (IQR 4-5)]. Items capturing ethicality and stigma like “The module understood who I am and where I come from” had median scores of 5. Participants believed the modules were an effective way to help improve their own and their child’s health and well-being [median=5 (IQR 4-5)].

Conclusion
Findings demonstrate the acceptability of a tailored, technology-based, educational intervention for pregnant and postpartum individuals receiving MOUD and provide justification for further evaluation of the intervention’s effectiveness in a clinical setting. Technology-based interventions such as this may help reduce stigma and enhance prenatal education.

References: 1. Cleveland, L. M., McGlothen-Bell, K., Scott, L. A., and Recto, P. (2020) A life-course theory exploration of opioid-related maternal mortality in the United States. Addiction, 115: 2079– 2088.

2. Martin, C. E., Almeida, T., Thakkar, B., & Kimbrough, T. (2021). Postpartum and addiction recovery of women in opioid use disorder treatment: A qualitative study. Substance Abuse, 0(0), 1–8.

3. Martin, C. E., & Parlier-Ahmad, A. B. (2021). Addiction treatment in the postpartum period: An opportunity for evidence-based personalized medicine. International Review of Psychiatry, 0(0), 1–12.

4. Ondersma, S. J., Svikis, D. S., Lam, P. K., Connors-Burge, V. S., Ledgerwood, D. M., & Hopper, J. A. (2012). A Randomized Trial of Computer-Delivered Brief Intervention and Low-Intensity Contingency Management for Smoking During Pregnancy. Nicotine & Tobacco Research, 14(3), 351–360.

Diversity, Equity, and Inclusion:
The current study is an educational intervention that is informed by data capturing the expressed needs of the patients for whom it is designed. The modules were built to be patient-centered and accessible to people with all educational backgrounds. Patients from the perinatal addiction clinic reviewed the content of the modules to ensure that it was appropriate for the intended population and free of language that might be stigmatizing, confusing, or irrelevant from the patient perspective. The videos that make up the modules deliberately feature racially diverse providers and patients as well as content centered around patient reported needs.