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Oglala Sioux Tribe (OST) CHOICES Program
A culturally adapted version of CHOICES, an intervention to reduce alcohol-exposed pregnancies.
Oglala Sioux Tribe CHOICES,* a culturally adapted version of an evidence-based intervention to reduce alcohol-exposed pregnancy by reducing drinking and/or improving contraception, was administered to non-pregnant American Indian women at risk for an alcohol-exposed pregnancy. The Motivational Interviewing–based intervention consisted of either two or four sessions of face-to-face personalized feedback on drinking and pregnancy risk. Participants tracked drinking, sexual activity, and contraception use and received contraception referrals.
* CHOICES (Changing High-risk alcohol use and Increasing Contraception Effectiveness Study) is an evidence-based screening and brief intervention to prevent alcohol-exposed pregnancy, which provides information on use of contraception and avoidance of drinking alcohol.
Outcomes
Reduced risk of alcohol-exposed pregnancy among women still participating 3 months after the intervention.
At least half of participants (53%) were no longer at risk for alcohol-exposed pregnancy at the 3-month follow-up. While a somewhat larger proportion was at risk at the 6-month follow-up, the proportion was still statistically lower than at baseline. Results were affected by loss to follow-up but suggested a significant decrease in risk for alcohol-exposed pregnancy, mostly due to increased use of contraception and not a reduction in drinking.
Costs
High start-up cost due to training of interventionists; moderate ongoing cost due to individual delivery of the intervention.
Start-up costs involve training of interventionists, acquiring space for training and intervention delivery, adapting curriculum, and obtaining telephones. If using local health providers, the costs could be potentially lower if embedded in existing services.
Cultural Engagment
Tribally run program delivered by community members. Cultural modification of materials.
The intervention incorporated community input by adding local images and data to the curriculum; adjusting readability level; changing survey wording and activity measurements; and including the most common types of alcohol consumed in the communities and what contraception is available at the local clinics. Intervention staff consisted of community members. The program is described as Tribally run.
Participants
Young Adult, Adult; Native; Female
Setting
Community Wide, Reservation, Urban
Delivery
Individual, Face-to-Face
Oglala Sioux Tribe CHOICES was implemented among reservation-based and urban Native women.
Participants were recruited from three midwestern Northern Plains Indian settings, which included two Oglala Lakota (Pine Ridge) reservations and one nearby urban setting. Participants were American Indian females (n = 193, mean age 29 years) at risk for having an alcohol-exposed pregnancy (i.e., consuming large amounts of alcohol, and not using contraception or using it incorrectly).
Staffing Needs
Community Member
Members of the community who lived healthy, positive lives delivered the intervention.
Tribal community clinics decided who should deliver the intervention and chose existing health workers/clinic staff from a variety of fields and specialty training backgrounds. It was unclear if a certain level of education was needed to implement the program, as it requires some motivational interviewing training.
Research Design
Pre-/post-intervention data
Developmental stage of research
Feasibility and acceptability were demonstrated, but further research is required to demonstrate efficacy.
This research employed a pre- and post-intervention design (baseline, 3- and 6-month follow-up) with participants recruited using non-random methods. Though lacking a comparison group and experiencing a high loss to follow-up, this intervention shows promising results and strong indicators of community acceptability and readiness for this type of program.
Potential
CHOICES demonstrated transportability to a Native community in Oglala Sioux Tribe CHOICES, supporting further implementation elsewhere.
Oglala Sioux Tribe CHOICES demonstrates transportability; materials would need to be modified to keep the intervention geographically and culturally appropriate. One potential limitation is that a community must be open to inclusion of contraception. This intervention is distinctive because it demonstrated that a Native community was open to including a contraception component in an FASD prevention intervention.
References
Hanson JD, Nelson ME, Jensen JL, Willman A, Jacobs-Knight J, Ingersoll K. Impact of the CHOICES intervention in preventing alcohol-exposed pregnancies in American Indian women. Alcohol Clin Exp Res. 2017;41(4):828-835.
https://www.ncbi.nlm.nih.gov/pubmed/28173632. https://doi.org/10.1111/acer.13348.
Hanson JD, Pourier S. The Oglala Sioux Tribe CHOICES Program: Modifying an existing alcohol-exposed pregnancy intervention for use in an American Indian community. Int J Environ Res Public Health.2016;13(1):ijerph13010001. https://www.ncbi.nlm.nih.gov/pubmed/26703670. https://doi.org/10.3390/ijerph13010001.
Associated
Hauge CH, Jacobs-Knight J, Jensen JL, et al. Establishing survey validity and reliability for American Indians through "think aloud" and test-retest methods. Qual Health Res. 2015;25(6):820-830. https://journals.sagepub.com/doi/pdf/10.1177/1049732315582010. https://doi.org/10.1177/1049732315582010.
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