BACKGROUND: Pregnant and parenting women consistently show low rates of engagement and retention in substance use disorder (SUD) treatment. While pregnancy enhances motivation and commitment to treatment, this population faces unique barriers to accessing care. Co-design is an approach that proactively engages service users to create a care system shaped to meet their needs. This study evaluated an adapted experience-based co-design (EBCD) process involving SUD treatment staff and parenting women with SUD (WWLE).
METHODS: Semi-structured interviews with WWLE and SUD treatment staff were conducted to develop content for the co-design process and identify barriers and facilitators to treatment. These data were analyzed using the principles of Trauma Informed Care (TIC). Multiple data sources were utilized to evaluate the co-design implementation, including semi-structured interviews, ethnographic observation, and discussion transcripts of EBCD launch events. The Integrated Promoting Action on Research in Health Services (i-PARIHS) framework informed tool development and data analysis of the co-design implementation.
RESULTS: The full sample across all stages of the EBCD implementation totaled 34 individuals (WWLE =13 and SUD staff = 21). Findings highlighted the importance of TIC in small pivotal moments that either enhance or diminish treatment engagement and retention. For the evaluation, WWLE reported having a valued voice in the co-design process and attributed their comfort level to small, equally represented workgroups, skilled facilitation and pre-existing, respectful relationships with staff. Professionals expressed commitment to the concept of co-design, but displayed mixed perspectives about the value of EBCD. Complex regulations, limited funding, and uncertainties during start-up presented challenges to the co-design process. Use of a remote platform created accessibility for participants, but presented challenges to communication and relationship building.
CONCLUSION: This research demonstrates how the core components of EBCD foster meaningful engagement of WWLE and can effectively create a collaborative co-design process that manages inherent power disparities between WWLW and treatment staff. The TIC analysis provides insight into aspects of care that encourage or deter women from treatment. This research illuminates the importance of integrating a TIC approach throughout a co-design initiative. Co-design presents an opportunity to create women-centered care and health equity in SUD treatment. / 2024-11-08T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45320 |
| Date | 09 November 2022 |
| Creators | Bosak, Julie |
| Contributors | Declercq, Eugene R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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