< Back to all interventions for Prevention of Fetal Alcohol Spectrum Disorders
Media Campaign and Remotely Delivered Screening and Brief Intervention (CHOICES)
Telephone delivery of an evidence-based intervention to prevent alcohol-exposed pregnancy followed a widespread media campaign.
Development and dissemination of a culturally and linguistically appropriate social media campaign served as both a universal prevention program for fetal alcohol spectrum disorders (FASD) and a recruitment tool for the prevention intervention. The campaign included culturally tailored posters, billboards, radio ads and interviews, brochures, newspaper ads, t-shirts, and pens. The prevention intervention was based on CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study), an evidence-based screening and brief intervention to prevent alcohol-exposed pregnancy, which provides information on use of contraception and avoidance of drinking alcohol. The intervention was delivered remotely to non-pregnant Native women using telephone calls and mailed materials.
Outcomes
Reductions in alcohol measures and risk for alcohol-exposed pregnancy attenuated by low retention.
Statistical modeling found all alcohol measures to have decreased significantly. The proportion of women engaging in unprotected sex and the percentage of women at risk for alcohol-exposed pregnancy decreased modestly but in a statistically significant manner. However, this was tempered by an extremely high loss to follow-up; the number of participants dropped from 231 to 51 by the final 12-month follow-up.
Costs
Start-up costs for media campaign plus intervention would be high but lower ongoing costs.
Initial costs include development and dissemination of a Tribally specific FASD awareness media campaign, costs for purchasing motivational interviewing (MI)-based workbooks, mailing and phone, and for training of staff in motivational interviewing techniques. Ongoing costs are not likely to be high if trained staff are retained, but the costs of phone contacts are unclear.
Cultural Engagment
Cultural adaptation and Tribal input on media campaign but not clear for intervention.
The media campaign was based on focus groups with Tribal members, administered by three Tribal liaisons. The campaign employed Native language in program materials, positive Native pregnancy images, themes, and cultural events. There was no description of cultural elements included in the phone-based intervention. The intervention was administered to Tribes that expressed interest and approval prior to implementation.
Participants
Young Adult, Adult; Native; Female
Setting
Community Wide, Reservation, Rural
Delivery
Individual, Multi-level, Telephone Call
Non-pregnant AI/AN women of childbearing age from three Tribes in the Northern Plains.
The media campaign and intervention were conducted among three American Indian Tribes in the Northern Plains. The media campaign, which was delivered to all residents of the Tribal communities, facilitated recruitment for the individual-level intervention. A total of 231 non-pregnant women of childbearing age participated in the CHOICES intervention. A subset of these, who had been recruited via the media campaign, provided feedback on the campaign.
Staffing Needs
Not Specified
Media campaign administered by Tribal liaisons; no information about staffing for phone-based intervention.
Research Design
Pre-/post-intervention data
Developmental stage of research
The CHOICES intervention employed a pre- and post-program evaluation design without random assignment or comparison group. The findings were tempered by extremely high loss to follow-up; the number of participants dropped from 231 to 51 by the final 12-month follow-up.
Potential
Telephone-based intervention to prevent alcohol-exposed pregnancy, aided by culturally appropriate media campaign, shows promise to reduce alcohol use and alcohol-exposed pregnancy.
This remotely delivered intervention based on Project CHOICES, an evidence-based intervention, has high impact potential, particularly when employed in combination with a culturally appropriate media and recruitment campaign. Despite high drop out and the lack of a comparison group, this intervention and phone-based interventions for remote and rural communities hold great promise. As this intervention may be relatively inexpensively applied after initial setup costs, it has a high impact-to-cost ratio potential.
References
Hanson JD, Winberg A, Elliott A. Development of a media campaign on fetal alcohol spectrum disorders for Northern Plains American Indian communities. Health Promot Pract. 2012;13(6): 842-847. https://www.ncbi.nlm.nih.gov/pubmed/22167361. https://doi.org/10.1177/1524839911404232.
Hanson JD, Miller AL, Winberg A, Elliott AJ. Prevention of alcohol-exposed pregnancies among nonpregnant American Indian women. Am J Health Promot. 2013;27(3 Suppl):S66-S73. https://www.ncbi.nlm.nih.gov/pubmed/23286666. https://doi.org/10.4278/ajhp.120113-quan-25.
< Back to all interventions for Prevention of Fetal Alcohol Spectrum Disorders