Development of Maternal Alcohol Reduction Interventions (MARI)

Research question: What should maternal alcohol interventions include and how can they be delivered to maximise accessibility? Background: Nondependent hazardous maternal drinking is common and increases risk of harm to women and children. This results in intergenerational transfer of alcohol harms with far-reaching consequences.

Drinking is a gendered behaviour, and there are calls for women-specific interventions to support women to adhere to alcohol recommendations relevant to their circumstances. Yet women-focused alcohol healthcare is lacking and there are no maternal-specific interventions.

Aims/Objectives: To coproduce inclusive maternal alcohol interventions (women trying to conceive, pregnant, mothers of young children).

The primary goal is to support maternal populations, without alcohol use disorder, adhere to relevant alcohol recommendations.

We will achieve this by synthesising outputs across three workpackages to deliver: coproduced interventions, content focusing on women s lives/needs, evidence on intervention usability/acceptability.

Methods: Our theoretically driven proposal follows MRC/NIHR guidelines for developing complex interventions, and is shaped by maternal/professional stakeholders.

We have reviewed existing evidence, generated new evidence, worked with stakeholders to understand what is wanted/needed, and the best ways to meet these needs.

Workpackage 1: Coproducing a tailored digital intervention (web-app) available as a smartphone-app or web-based resource. Incorporating evidence-based behaviour change techniques, framed for maternal groups.

Translating online content into non-digital resources for the public and professional stakeholders (e.g., pamphlets/posters, stakeholder guides) accessible through public spaces, community organisations, health services.

Interventions will help women understand alcohol s role in their lives, provide healthy strategies to support wellbeing, provide clear/consistent evidence/explanations, provide lived experience examples of women s success in reducing drinking and the benefits of this to women/children.

The stakeholder guide will provide a better understanding of maternal drinking and ways to talk with women to promote trust and deliver compassionate support.

Workpackage 1 will adopt the experience-based co-design framework, enabling coproduction of interventions on emotive subjects utilising appropriate participatory action research activities. Coproduction sessions will be attended by a diverse range of people.

An independent facilitator will run these following principles of power-sensitive Transdisciplinary Action Research , enabling equal group power dynamics.

Workpackage 2: Transcripts from maternal interviews will be transformed into lived experience films, incorporated across interventions.

Roleplay films will be created for professional stakeholders to better understand how to engage with women around alcohol. Workpackage 3: Initial intervention/resource usability/acceptability will be assessed. Participants will have access to the interventions/resources for 5 weeks before evaluating their use/content.

Timeline: Ethics will be obtained prior to start date. Workpackage 1 (months 1-9), Workpackage 2 (1-5), workpackage 3 (6-12). Timeline is achievable due to completed preparation work and established buy-in from public/professional stakeholders.

Anticipated Impact/Dissemination: Interventions/resources ready for use and future cost-effectiveness/evaluation research. Interventions which meet current priorities for developing women-specific health interventions.

Increasing the proportion of maternal groups adhering to relevant alcohol guidelines can reduce serious harms (e.g., fetal alcohol spectrum disorder) and improve wellbeing of women/children.

Interventions will be free, and accessible in a variety of formats to enhance inclusivity and provide a toolkit for healthcare professionals, which will improve services in a time efficient manner