Applying the Transcreation Framework to Design the Recovery Coach Doula Role and Delivery Model to Support Individuals with Substance Use Disorder in the Perinatal Period

Background: Treating perinatal substance use disorder is a public health priority. Social support is associated with better substance use and perinatal outcomes. Doula care and recovery coaching from peers who are in recovery themselves are two evidence-based interventions designed to provide social support. The aim was to braid doula care and peer recovery coaching into a novel healthcare personnel role and develop a delivery model for implementation in community settings. Methods: A team led by community members from the recovery and birth justice communities and perinatal clinicians, with a policy analysts, and an implementation scientist applied the Transcreation Framework guided by extant literature, theory, formative research, and existing community infrastructure in weekly or biweekly sessions over three years. Results: The team identified a strong evidentiary foundation for Recovery Coach Doula care and supportive community infrastructure. Through theory analysis and formative research, the team identified 15 core functions of the Recovery Coach Doula role and developed a delivery model. The core functions were intentionally designed to be adaptable to allow Recovery Coach Doulas to meet the needs of their clients. To deliver Recovery Coach Doula care in community settings, the team created a hub and spoke model delivery program to accommodate varying healthcare models and center the needs of the Recovery Coach Doulas, as well as the clients. The transcreation process provided structure required for rigorous co-design over an extended period time with iteration. Conclusions: Systematic application of the Transcreation Framework with community laid the foundation for implementation of Recovery Coach Doula care. Next steps include rigorously testing the effectiveness of Recovery Coach Doula care and developing implementation strategies and outcomes.