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Background Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e–SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e–SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e–SBI-HV prototype and describe the e–SBI-HV prototype. Methods Adaptation of the original e-SBI into the e–SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e–SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results The e–SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor–client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e–SBI-HV prototype included 2 digital intervention 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. Despite the described 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, the e–SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e–SBI-HV.
Background Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e–SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e–SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e–SBI-HV prototype and describe the e–SBI-HV prototype. Methods Adaptation of the original e-SBI into the e–SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e–SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results The e–SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor–client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e–SBI-HV prototype included 2 digital intervention 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. Despite the described 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, the e–SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e–SBI-HV.
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
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