TY - JOUR
T1 - The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women
AU - Katz, Kathy S.
AU - Blake, Susan M.
AU - Milligan, Renee A.
AU - Sharps, Phyllis W.
AU - White, Davene B.
AU - Rodan, Margaret F.
AU - Ross, Maryann
AU - Murray, Kennan B.
N1 - Funding Information:
The authors wish to acknowledge the participation of Lenora Johnson, in the development of the early drafts of the smoking intervention curriculum and offer their appreciation to Haziel Laryea, David G. Miller, Jelili Ojodu, and Barbara Wingrove, former NICHD project officer for the study, for their valuable support in the implementation of the study. We are grateful to the counseling staff of Ashawnda Fleming, Trina Frazier, Bita Pishevar Haynes, and Tiffani Toston, for their skill and diplomacy in conducting the intervention. We also wish to thank the prenatal clinic staff and administrators at Chartered Family Health Center, George Washington University Medical Center, Howard University Hospital, Providence Hospital and Washington Hospital Center for their cooperation in the study. This research was supported by a Cooperative Agreement funded by the National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities (Grant numbers: 3U18HD030445; 3U18HD030447; 5U18HD31206; 3UHD031919; 5U18HD 036104). The following institutions and investigators participated in the NIH-DC Initiative to Reduce Infant Mortality in Minority Populations in the District of Columbia: Children's National Medical Center – J. Joseph (principal investigator); George Washington University Medical Center – A. El-Mohandes (principal investigator); Georgetown University Medical Center – K. N. SivaSubramanian (principal investigator); Howard University – A. Johnson (principal investigator); Research Triangle Institute – M.N. El-Khorazaty (principal investigator); and NIHCD – M Kiely Project Officer.
PY - 2008/6/25
Y1 - 2008/6/25
N2 - Background: African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format. Methods: Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported. Results: Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended ≥ 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were fully completed (where all required risk content was covered). Ninety-three percent of the subsample of intervention women had a positive view of their relationship with their counselor. Most intervention women found the session content helpful. Implementation challenges of addressing multiple risk behaviors are discussed. Conclusion: While implementation adjustments and flexibility are necessary, multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services, and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions.
AB - Background: African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format. Methods: Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported. Results: Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended ≥ 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were fully completed (where all required risk content was covered). Ninety-three percent of the subsample of intervention women had a positive view of their relationship with their counselor. Most intervention women found the session content helpful. Implementation challenges of addressing multiple risk behaviors are discussed. Conclusion: While implementation adjustments and flexibility are necessary, multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services, and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions.
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U2 - 10.1186/1471-2393-8-22
DO - 10.1186/1471-2393-8-22
M3 - Article
C2 - 18578875
AN - SCOPUS:48249084563
SN - 1471-2393
VL - 8
JO - BMC pregnancy and childbirth
JF - BMC pregnancy and childbirth
M1 - 22
ER -