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

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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

Estimates of changes or differences in alcohol-related problems and the stability of those changes or differences. 

Medium/Mixed Level of Change

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

Two domains estimating start-up and ongoing expenses. 

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 Engagement

Two indicators of cultural and Tribal/community contributions. 

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.

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

Credentials and/or background of personnel who delivered the intervention. 

Not Specified

Media campaign administered by Tribal liaisons; no information about staffing for phone-based intervention. 

Research Design

Methods employed to gather research data. 

Pre-/post-intervention data

Developmental stage of research

Stage of development of the evidence supporting this intervention. 

Unknown

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

Narrative offered by expert reviewers providing overall comments or evaluations about the intervention. 

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

Primary 

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 .

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