Co-designing a mobile application to reduce self-stigma for people with opioid use disorder during pregnancy and the...

Pregnant and postpartum individuals (PPI) face unique challenges to recovery from opioid use disorder (OUD), including stigma from self and others. Enhearten is a mobile application featuring an ecological momentary intervention to reduce self-stigma and provide support for perinatal individuals with OUD. This study aimed to refine and test Enhearten using the Discover, Design/Build, and Test (DDBT) framework. We hypothesized that DDBT would be associated with increased intervention acceptability, and Enhearten would be associated with decreased self-stigma among PPI with OUD.

In this fully-remote study, participants provided human-centered design feedback in semi-structured interviews at 1-month to guide adaptations. Participants also completed structured questionnaires including validated measures of self-stigma at baseline, 1-month, and 2-month follow-ups and technology acceptance at 1-month and 2-month follow-ups. Paired samples t-tests determined whether differences existed between baseline and 2-month self-stigma and between 1-month and 2-month technology acceptance.

Twenty PPI (40% pregnant, 60% postpartum) representing diverse geographic U.S. regions used Enhearten. Qualitative findings highlighted the value of peer support and positive framing but revealed modifiable barriers and a desire for additional features. Human-centered design feedback guided adaptations, including added discussion group features and enhanced relevance of messages. Quantitatively, self-stigma decreased from baseline (M=2.70, SD=0.47) to 2-month (M=2.27, SD=0.61), t(19)=-2.902, p=0.009 (Cohen's d=0.742). Technology acceptance was high at 1-month and increased by 2-month, t(15)=3.211, p=0.006.

These results support the potential of digital interventions to reduce self-stigma and improve perinatal OUD recovery outcomes. The DDBT framework provides structure to understand lived experiences, adapt rapidly, and evaluate digital intervention efficacy.