Helpline Delivery of Brief Interventions for Postpartum Heavy Episodic Drinking

Abstract The proposed R34 will develop and test digital helpline intervention components aimed at reducing heavy episodic drinking (HED) during the first 3 months postpartum. HED is prevalent among women of reproductive age, and more than half of women who reduce their drinking during pregnancy return to pre-pregnancy levels within 3 months postpartum, making this a critical time for intervention. Addressing postpartum HED is key to preventing negative maternal and child health outcomes, including fetal alcohol spectrum disorder in subsequent pregnancies. Postpartum mothers are unlikely to seek treatment for HED, due to stigma and fear of child removal. Helplines that use real-time synchronous text with a professional, as well as automated messaging, are a promising mechanism for reaching postpartum mothers to deliver effective brief interventions for HED, as they are widely accessible, convenient, free, and anonymous. The proposed study will apply the Multiphase Optimization Strategy (MOST) framework to develop standard helpline interventions (assessment, psychoeducation, and links to resources), and evidence-based brief interventions for alcohol use (motivational interviewing and coping skills training), all tailored to the postpartum period and delivered via scheduled sessions of synchronous texting with a helpline specialist. The standard helpline component will also include the asynchronous support typical of helplines. Following development, a pilot factorial trial will evaluate the standard helpline interventions for this unique population, examine the feasibility and added value of evidence- based brief interventions delivered via helpline, and assess the added impact of 4 weeks of automated messages to provide ongoing reinforcement of intervention content. Specific aims are to (1) develop intervention components, Helpline staff training, and fidelity monitoring protocols via an iterative user-centered design process with 15 mothers, 5 helpline specialists, and an expert panel; and (2) conduct a pilot 2X2X2 factorial trial with 120 new mothers to assess feasibility, acceptability, and fidelity of each intervention component, and obtain preliminary proof-of-concept effects of intervention components on proximal (motivation, self-efficacy, and self-regulation) and distal (quantity and frequency of HED) outcomes to prepare for a future fully-powered optimization trial. Study products will be a set of piloted intervention components for delivery via digital helpline, ready for optimization and evaluation in an R01. Partnership to End Addiction’s existing Helpline infrastructure will support future testing and ultimate scalability.