Program

Oct 01, 2009

OVERVIEW

DC HOPE, or Healthy Outcomes of Pregnancy Education, is a clinic-based intervention targeting multiple behavioral and psychosocial risk factors among pregnant African American and Latina women residing in Washington, DC. Risk factors include active and passive smoking, depression, and intimate partner violence. Women are presented with materials during intervention sessions requiring active participation such as identifying smoking triggers. In one study, African American women were randomly assigned to the intervention or usual care group. Among this study population, there were no impacts on risk factor distribution between the intervention and usual care groups at first or second follow-up-i.e., during the second or third trimester.

DESCRIPTION OF PROGRAM

Target population: High-risk pregnant African American and Latina women

DC HOPE, or Healthy Outcomes of Pregnancy Education, is a clinic-based intervention targeting multiple behavioral and psychosocial risk factors among pregnant African American and Latina women living in Washington, DC. Targeted risk factors include active and passive smoking, depression, and intimate partner violence. Women were eligible for the program if they were 18 years of age or older, less than 29 weeks pregnant, self-identified as African American or Latina, and had at least one of the four targeted risk factors.

DC HOPE is delivered across eight sessions, immediately before or after a routine prenatal care visit. Sessions last, on average, 35 minutes. Women are presented with materials during sessions requiring active participation such as identifying smoking triggers; materials include a quit smoking videotape and take-home guide along with PowerPoint visual aids.

Pregnancy advisors are assigned to a clinic and receive three weeks training in addition to ongoing supervision, and were trained to address and integrate multiple risk factors to reflect each participant’s risk and need. The majority of the pregnancy advisors had a master’s degree in areas such as counseling psychology as well as experience in interpersonal counseling, health education, or behavior change. In each session, the pregnancy advisor and participant develop a tailored “homework” plan to reinforce sessions at home. Participants were compensated for their involvement, including $5 after completing the initial eligibility assessment, $15 after completing each telephone interview, and a 30-minute telephone card after providing consent. This program incorporated portions of the Smoking Cessation or Reduction in Pregnancy Treatment (SCRIPT) trial as well as the Transtheoretical Model, pathways to change self-help manual, and Cognitive-Behavioral Therapy.

EVALUATION(S) OF PROGRAM

Joseph, J.G., El-Mohandes, A.A.E., Kiely, M., El-Khorazaty, N., Gantz, M.G., Johnson, A.A., Katz, K.S., Blake, D.M., Rossi, M.W., Subramanian, S. (2009). Reducing Psychosocial and Behavioral Pregnancy Risk Factors: Results of a Randomized Clinical Trial Among High-Risk Pregnant African American Women. American Journal of Public Health, 99(6): 1053-1061.

Evaluated population: The study sample included 913 high-risk pregnant African American women 18 years of age or older residing in Washington, DC. The majority of women in the study (60%) were in their first trimester of pregnancy; 24% were married or living with a partner; 76% reported that their pregnancy was wanted; and 69% had a previous live birth. While depression was included as a risk factor, women who had positive screens for suicidal ideation were immediately referred for emergency consultation and excluded from the study.

Approach: Women were randomly assigned to the intervention group (n=453) or usual care group (n=460). Telephone-based survey data were collected at baseline, first follow-up (second trimester), and second follow-up (third trimester). Using validated instruments, surveys assessed smoking, secondhand smoke exposure, depression, and intimate partner violence along with sociodemographic characteristics among study participants. Two separate analyses were performed: one examined the distribution of risk factors among women in the intervention and usual care groups, while the other examined within-in person change overtime. Intervention and follow-up activities occurred between July 2001 and July 2004.

Results: There were no significant impacts on the distribution of risk factors between the intervention and usual care groups at first or second follow-up. In a separate analysis, looking at change from baseline to second follow-up, women in the intervention group were significantly more likely to resolve at least one of their risks compared with women in the usual care group (odds ratio: 1.6), with a small effect size (d=.26). While eight sessions were offered, the authors note there was low compliance among women in the intervention group, as only 54% of women attended at least four sessions.

SOURCES FOR MORE INFORMATION

References

Joseph, J.G., El-Mohandes, A.A.E., Kiely, M., El-Khorazaty, N., Gantz, M.G., Johnson, A.A., Katz, K.S., Blake, D.M., Rossi, M.W., Subramanian, S. (2009). Reducing Psychosocial and Behavioral Pregnancy Risk Factors: Results of a Randomized Clinical Trial Among High-Risk Pregnant African American Women. American Journal of Public Health, 99(6): 1053-1061.

Katz, K.S., Blake, S.M., Milligan, R.A., Sharps, P.W., White, D.B., Rodan, M.F., Rossi, M., Murray, K.B. (2008). The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women. BMC Pregnancy and Childbirth, 8:22.

KEYWORDS: Female-specific, Black/African American, High-Risk, Clinic-based, Urban, Depression, Mood Disorders, Tobacco use, Any substance use

Program information last updated on 10/1/09.

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