Project BETTER: A technology-delivered intervention for pregnant people with opioid use disorder (Preprint)
Authors: Parlier-Ahmad Anna Beth , Eglovitch Michelle , Martin Sarah , Svikis Dace S. , Martin Caitlin E. 
Published: June 2022

BACKGROUND

Opioid overdose is a leading cause of pregnancy-associated deaths largely occurring after delivery. Birthing people with opioid use disorder (OUD) face unique stressors during the transition from pregnancy to postpartum that are challenging to recovery and increase overdose risk. Prenatal education is insufficient to prepare birthing people with OUD for the pregnancy-to-postpartum transition. Use of evidence-based, technology-delivered interventions as a supplement to standard prenatal care may provide more robust preparation for those facing this transition. To date, no technology-based interventions specific to the pregnancy-to-postpartum transition for people receiving MOUD have been developed and evaluated.

OBJECTIVE

The primary aim of this manuscript is to describe the iterative development process of a novel technology-delivered intervention tailored for pregnant people receiving medication for OUD (MOUD) as it underwent refinement in preparation for its subsequent evaluation in a prospective randomized clinical trial.

METHODS

Three evidence-based technology-delivered intervention modules were developed and are described. Formative data from patients and providers identified module content: 1) recovery-oriented strategies for the pregnancy-to-postpartum transition, 2) guidance around caring for an infant with withdrawal symptoms, and 3) preparation for child welfare interactions. Module content matching these content areas was reviewed in successive rounds by an expert panel and modified by the study team. Then, novel modules were programmed into the web-based, easily accessible platform where information is delivered via professionally produced videos and an interactive narrator using behavioral techniques. Pregnant and postpartum people receiving MOUD pre-tested the modules and provided feedback in semi-structured interviews. Feedback from the expert panel and patient pre-testing is summarized.

RESULTS

Expert panel members (n=15) including patients, multidisciplinary providers, and technology-based intervention researchers identified module strengths and areas for improvement. Panel members liked the intervention format and the informative content. Primary areas for improvement included adding content, providing more structure to help participants navigate the intervention more easily, and revising language. Pre-testing participant (n=9) qualitative data highlighted four themes: reactions to intervention content, navigability of the intervention, feasibility of the intervention, and recommendation of the intervention. Participants also provided some areas for improvement. All iterative feedback was incorporated into final modules for the prospective randomized clinical trial.

CONCLUSIONS

When developing technology-delivered interventions tailored for pregnant people receiving MOUD, it is feasible (and recommended) for the intervention to be informed by patient-reported needs and multidisciplinary perspectives. Assessment of intervention feasibility, acceptability, and effectiveness with a large sample in a clinical research setting is warranted.