THRIVE: Teaching Health promotion and Resilience in Varied Environments: a peer-led intervention following hospital discharge

University Of Pennsylvania, Philadelphia PA

Investigators

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Abstract

People who use drugs (PWUD) with acute medical problems have high rates of subsequent mortality and morbidity related to substance use. While health promotion strategies to reduce overdose and injection-related complications have historically functioned outside of health care settings, integrating health promotion strategies into acute care clinical settings could improve these outcomes. There is a critical gap in how best to implement health promotion strategies for PWUD in the health system that will lead to effective behavioral change. Our study proposes to develop an acceptable, feasible, and effective peer-led bundle of health promotion strategies. Our overall objectives are to tailor the THRIVE (Teaching Health promotion and Resilience in Varied Environments) intervention and determine its efficacy in changing behaviors and reducing health risks among PWUD. The THRIVE intervention was conceptualized by our team along with people with lived experience and informed by the COM-B model for Behavior Change and the Theoretical Domains Framework. THRIVE includes a face-to-face session boosted by weekly text messages and electronic content. Content is delivered over 12 weeks. Our research team has the extensive expertise needed to successfully complete the proposed aims. We will use a human-centered design approach to tailor the THRIVE model and address the patient, provider, and systems-level barriers to implementation in hospital and emergency-department settings. This includes a “Design Sprint” in which PWUD will map the problem (guided by qualitative interviews with patients and healthcare providers), sketch implementation elements, choose the key aspects to develop, and build model components. We will then examine the efficacy of the THRIVE intervention in reducing the cumulative incidence of self-reported non-fatal overdose or skin and soft tissue infection between baseline and 6-months among PWUD in a hybrid type 1 randomized controlled trial. We will conduct a randomized controlled trial recruiting patients (n=390) admitted to the hospital or Emergency Department with opioid use disorder in one of three hospitals. We will also analyze implementation barriers and facilitators of the THRIVE model to identify any needed implementation supports for widescale implementation. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.