Design of a mobile application for universal screening for women of child-bearing age engaged in comprehensive addiction and recovery environments (WE-CARE) for substance use and women from the general population

Objective: Formative research was conducted to identify barriers to universal screening for alcohol/substance use, depression, and anxiety in women of childbearing age (WOCA,18–44 years of age) drawn from the general population and from women in a residential treatment program for alcohol and/or drug use. Methods: E-surveys (n = 467), focus groups with women aged 18–44 (n = 30), and in-depth interviews (IDIs) with healthcare providers (HCPs, n = 8) were conducted to create a user-centered design for a mHealth application. Results: E-surveys revealed that 80% of the women were asked about alcohol use at a visit with their HCP, while 70% were asked about drug use. Only 35% of the respondents indicated an HCP discussed their answers with them. Two focus groups with WOCA revealed minimal to no prior knowledge of risk factors related to alcohol and substance use. Barriers to treatment identified included a lack of readiness to change, cost, minimal social support systems, and a perceived sense of public stigma. In-depth interviews with HCPs revealed not all HCPs use screenings for substance use due to lack of time to conduct a screening, unfamiliarity with standardized screening tools, insufficient training to provide proper follow-up care, no mandates requiring such screenings, and a concern that asking follow-up questions may negatively impact their relationship with the client. Conclusion: Results from the formative research studies were used to inform the design and development of the WE-CARE app prototype. The prototype, which includes educational content on alcohol and substance use disorders (SUDs), a moderated discussion forum, FAQs, and a Chatbot to encourage participants to make an appointment with an SUD treatment center if indicated, is undergoing pilot testing.