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.
