Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: A Qualitative Description of Intervention Development (Preprint)

Abstract

BACKGROUND Perinatal substance use (SU) is prevalent and may increase risks to maternal and child health. Many pregnant and postpartum people do not seek treatment for SU due to fears of child removal. Home visiting (HV), a voluntary supportive program for high-risk families in the perinatal period, is a promising venue for addressing unmet SU needs. Confidential delivery of screening and brief intervention for SU via computer has demonstrated high user satisfaction among pregnant and postpartum people as well as efficacy in reducing perinatal SU. This study describes the development of Electronic Screening and Brief Intervention for Home Visiting (e-SBI-HV), a digital screening and brief intervention program that is tailored to the HV context. OBJECTIVE Study objectives are to (1) describe the user-centered intervention development process that informed the development of e-SBI-HV components; (2) present the results of qualitative interviews with home visitors and clients that informed e-SBI-HV development; and (3) describe the e-SBI-HV prototype. METHODS e-SBI-HV development followed a user-centered design process that included iterative cycles of interviews with home visitors and clients. Feedback gathered during each interview cycle was integrated into the e-SBI-HV design. Participants included 17 home visitors and 7 clients across three Healthy Families America programs in New Jersey. RESULTS Round 1 interviews yielded 7 themes: (1) characterizing HV clients who use substances; (2) challenges to addressing SU in HV; (3) best practices for addressing SU in HV; (4) home visitor training and experience; (5) barriers to treatment; (6) technology in HV; and (7) e-SBI-HV implementation challenges and benefits. In Round 2, 7 additional themes emerged: (1) potential client concerns; (2) home visitor positive feedback; (3) feedback on home visitor component; (4) feedback on specific e-SBI components; (5) additional information to include; (6) integration of e-SBI into routine HV; and (7) needs to be met in the future. The user-centered design process yielded a prototype of the e-SBI-HV, including two e-SBI sessions and home visitor facilitation protocols. CONCLUSIONS This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Findings of the interviews indicate the complexity of addressing SU in the HV context, and directly informed the content and structure of the e-SBI-HV. Despite noted challenges, home visitors and clients generally reacted favorably to the e-SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, e-SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding overburdening home visitors. The next step in this research is to test the feasibility and preliminary efficacy of the e-SBI-HV. CLINICALTRIAL ClinicalTrials.gov NCT03750487