The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women

• Published in: BMC pregnancy and childbirth 2008-06, Vol.8 (1), p.22-22, Article 22
• Main Authors: Katz, Kathy S, Blake, Susan M, Milligan, Renee A, Sharps, Phyllis W, White, Davene B, Rodan, Margaret F, Rossi, Maryann, Murray, Kennan B
• Format: Article
• Language: English
• Subjects: Adult; Black or African American; Counseling - methods; Counseling - statistics & numerical data; Delivery of Health Care, Integrated - methods; Delivery of Health Care, Integrated - organization & administration; Depression - prevention & control; Feasibility Studies; Female; Humans; Mass Screening - methods; Patient Satisfaction; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - prevention & control; Pregnancy Complications - psychology; Prenatal Care - methods; Prenatal Care - statistics & numerical data; Preventive Health Services - methods; Preventive Health Services - organization & administration; Risk Factors; Risk Reduction Behavior; Sexually Transmitted Diseases - prevention & control; Smoking Cessation - methods; Socioeconomic Factors; Spouse Abuse - prevention & control; Stress, Psychological - epidemiology; Stress, Psychological - prevention & control; Tobacco Smoke Pollution - prevention & control; Tobacco Smoke Pollution - statistics & numerical data; United States; Urban Health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/1471-2393-8-22

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. 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. 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 > or = 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. 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