Brief FASD prevention intervention: physicians' skills demonstrated in a clinical trial in Russia

Tatiana Balachova, Barbara L Bonner, Mark Chaffin, Galina Isurina, Vladimir Shapkaitz, Larissa Tsvetkova, Elena Volkova, Irina Grandilevskaya, Larissa Skitnevskaya, Nicholas Knowlton, Tatiana Balachova, Barbara L Bonner, Mark Chaffin, Galina Isurina, Vladimir Shapkaitz, Larissa Tsvetkova, Elena Volkova, Irina Grandilevskaya, Larissa Skitnevskaya, Nicholas Knowlton

Abstract

Background: Alcohol consumption during pregnancy can result in a range of adverse pregnancy outcomes including Fetal Alcohol Spectrum Disorders (FASD). Risky drinking among Russian women constitutes a significant risk for alcohol-exposed pregnancies (AEP). Russian women report that obstetrics and gynecology (OB/GYN) physicians are the most important source of information about alcohol consumption during pregnancy and developing effective prevention interventions by OB/GYNs is indicated. This is the first study focused on implementation of an AEP prevention intervention at women's clinics in Russia.

Method: The paper describes the intervention protocol and addresses questions about the feasibility of a brief FASD prevention intervention delivered by OB/GYNs at women's clinics in Russia. Brief physician intervention guidelines and two evidence-based FASD prevention interventions were utilized to design a brief dual-focused physician intervention (DFBPI) appropriate to Russian OB/GYN care. The questions answered were whether trained OB/GYN physicians could deliver DFBPI during women's routine clinic visits, whether they maintained skills over time in clinical settings, and which specific intervention components were better maintained. Data were collected as part of a larger study aimed at evaluating effectiveness of DFBPI in reducing AEP risk in non-pregnant women. Methods of monitoring the intervention delivery included fidelity check lists (FCL) with the key components of the intervention completed by physicians and patients and live and audio taped observations of intervention sessions. Physicians (N = 23) and women (N = 372) independently completed FCL, and 78 audiotapes were coded.

Results: The differences between women's and physicians' reports on individual items were not significant. Although the majority of physician and patient reports were consistent (N = 305), a discrepancy existed between the reports in 57 cases. Women reported more intervention components missing compared to physicians (p < 0.001). Discussing barriers was the most difficult component for physicians to implement, and OB/GYN demonstrated difficulties in discussing contraception methods.

Conclusions: The results supported the feasibility of the DFBPI in Russia. OB/GYN physicians trained in the DFBPI, monitored, and supported were able to implement and maintain skills during the study. In addition to the alcohol focus, DFBPI training needs to have a sufficient component to improve physicians' skills in discussing contraception use.

Figures

Figure 1
Figure 1
Dual-Focused BPI protocol.
Figure 2
Figure 2
Fidelity Check List - 1st clinic visit (Women’s Form).
Figure 3
Figure 3
Fidelity Check List - 2nd clinic visit (Physicians’ Form).
Figure 4
Figure 4
Proportion of completed intervention components. 1The differences between women’s and physicians’ reports on individual items were not significant.

References

    1. American Academy of Pediatrics Committee on Substance Abuse and Committee on Children With Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics. 2000;106:358–361.
    1. Bertrand J, Floyd RL, Weber MK, O’Connor M, Riley EP, Johnson KA, Cohen DE. National Task Force on FAS/FAE. Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Atlanta: Centers for Disease Control and Prevention; 2004.
    1. Streissguth AP, O’Malley K. Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Semin Clin Neuropsychiatry. 2000;5(3):177–190. doi: 10.1053/scnp.2000.6729.
    1. Warren KR, Hewitt BG, Thomas JD. Fetal alcohol spectrum disorders: research challenges and opportunities. Alcohol Res Health. 2011;34(1):4–14.
    1. Abel EL, Sokol RJ. Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug Alcohol Depend. 1987;19:51–70. doi: 10.1016/0376-8716(87)90087-1.
    1. May PA, Gossage JP, Kalberg WO, Robinson LK, Buckley D, Manning M, Hoyme HE. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev. 2009;15(3):176–192. doi: 10.1002/ddrr.68.
    1. Miller LC, Chan W, Litvinova A, Rubin A, Comfort K, Tirella L, Cermak S, Morse B, Kovalev I. Fetal alcohol spectrum disorders in children residing in Russian orphanages: a phenotypic survey. Alcohol Clin Exp Res. 2006;30:531–538. doi: 10.1111/j.1530-0277.2006.00059.x.
    1. Riley EP, Guerri C, Calhoun F, Charness ME, Foroud TM, Li TK, Mattson SN, May PA, Warren KR. Prenatal alcohol exposure: advancing knowledge through international collaborations. Alcohol Clin Exp Res. 2003;27:118–135. doi: 10.1111/j.1530-0277.2003.tb02731.x.
    1. Palchik A, Legonkova S, Sofronova G. Этнические особенности проявления алкогольного синдрома плода [Ethnic features of fetal alcohol syndrome manifestation] Yakut Med J. 2011;34:22–25. (In Russian). .
    1. Landgren M, Svensson L, Strömland K, Andersson Grönlund M. Prenatal alcohol exposure and neurodevelopmental disorders in children adopted from Eastern Europe. Pediatrics. 2010;125:e1178–e1185. doi: 10.1542/peds.2009-0712.
    1. Floyd RL, O’Connor MJ, Sokol RJ, Bertrand J, Cordero JF. Recognition and prevention of fetal alcohol syndrome. Obstet Gynecol. 2005;106:1059–1064. doi: 10.1097/01.AOG.0000181822.91205.6f.
    1. Warren KR, Foudin LL. Alcohol-related birth defects-the past, present, and future. Alcohol Res Health. 2001;25(3):153–158.
    1. Centers for Diseases Control and Prevention. Alcohol use among pregnant and nonpregnant women of childbearing age: United States, 1991–2005. MMWR Morb Mortal Wkly Rep. 2009;58(19):529–532.
    1. Skagerstrom J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Womens Health. 2011;20:901–913. doi: 10.1089/jwh.2010.2216.
    1. Floyd RL, Decoufle P, Hungerford DW. Alcohol use prior to pregnancy recognition. Am J Prev Med. 1999;17:101–107. doi: 10.1016/S0749-3797(99)00059-8.
    1. Ethen MK, Ramadhani TA, Scheherele AE, Canfield MA, Wyszynsji DF, Druschel CM, Romitti PA. National birth defects prevention study. Matern Child Health J. 2007;13:274–285.
    1. Clarren SK, Astley SJ, Gunderson VM, Spellman D. Cognitive and behavioral deficits in nonhuman primates associated with very early embryonic binge exposures to ethanol. J Pediatr. 1992;121(5 Pt 1):789–796.
    1. Floyd RL, Ebrahim SH, Boyle CA. Observations from the CDC. Preventing alcohol-exposed pregnancies among women of childbearing age: the necessity of a preconceptional approach. J Womens Health Gend Based Med. 1999;8:733–736. doi: 10.1089/152460999319048.
    1. Balachova T, Bonner B, Chaffin M, Bard D, Isurina G, Tsvetkova L, Volkova E. Women’s alcohol consumption and risk for alcohol-exposed pregnancies in Russia. Addiction. 2012;107(1):109–117. doi: 10.1111/j.1360-0443.2011.03569.x.
    1. Kristjanson AF, Wilsnack SC, Zvartau E, Tsoy M, Novikov B. Alcohol use in pregnant and non-pregnant Russian women. Alcohol ClinExp Res. 2007;31:299–307. doi: 10.1111/j.1530-0277.2006.00315.x.
    1. Chambers CD, Kavteladze L, Joutchenko L, Bakhireva LN, Jones KL. Alcohol consumption patterns among pregnant women in the Moscow region of the Russian Federation. Alcohol. 2006;38:133–137. doi: 10.1016/j.alcohol.2006.06.002.
    1. The Project CHOICES Intervention Research Group. Reducing the risk of alcohol-exposed pregnancies: a study of a motivational intervention in community settings. Pediatrics. 2003;111(5):1131–1135.
    1. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;8(3):7–30.
    1. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2004;140(7):557–568. doi: 10.7326/0003-4819-140-7-200404060-00017.
    1. Chang G, Mcnamara TK, Orav EJ. Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol. 2005;105(5):991–998. doi: 10.1097/01.AOG.0000157109.05453.84.
    1. Hankin J, McCaul ME, Heussner J. Pregnant, alcohol-abusing women. Alcohol Clin Exp Res. 2000;24:1276–1286. doi: 10.1111/j.1530-0277.2000.tb02094.x.
    1. Chang G, Goetz MA, Wilkins-Haug L, Berman S, Hankin J, McCaul ME, Heussner J. A brief intervention for prenatal alcohol use: an in-depth look. J Subst Abuse Treat. 2000;18(4):365–369. doi: 10.1016/S0740-5472(99)00105-1.
    1. Manwell LG, Fleming MF, Mundt MP, Stauffacher EA, Barry KL. Treatment of problem alcohol use in women of childbearing age: results of a brief intervention trial. Alcohol Clin Exp Res. 2000;24:1517–1524. doi: 10.1111/j.1530-0277.2000.tb04570.x.
    1. O’Connor MJ, Whaley SE. Alcohol use in pregnant low-income women. J Stud Alcohol. 2003;64(6):773–783.
    1. Fleming MF, Lund MR, Wilton G, Landry M, Scheets D. The Healthy Moms study: the efficacy of brief alcohol intervention in postpartum women. Alcohol Clin Exp Res. 2008;32(9):1600–1606. doi: 10.1111/j.1530-0277.2008.00738.x.
    1. Nilsen P. Brief alcohol intervention to prevent drinking during pregnancy: an overview of research findings. Curr Opin Obstet Gynecol. 2009;21(6):496–500. doi: 10.1097/GCO.0b013e328332a74c.
    1. Chang G. Screening and prevention in prenatal care settings. Alcohol Res Health. 2004;28(2):80–84.
    1. Committee opinion No. 496. American College of Obstetricians and Gynecologists. At-risk drinking and alcohol dependence: obstetric and gynecologic implications. Obstet Gynecol. 2011;118:383–388. doi: 10.1097/AOG.0b013e31822c9906.
    1. Stade BC, Dzendoletas, Sgro M, Dowswell T, Bennett D. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy (Review) Cochrane Database Syst Rev. 2009;27
    1. Miller WR, Sorensen JL, Selzer JA, Brigham GS. Disseminating evidence-based practices in substance abuse treatment: a review with suggestions. J Subst Abuse Treat. 2006;31(1):25–39. doi: 10.1016/j.jsat.2006.03.005.
    1. Chang G. In: Encyclopedia on Early Childhood Development [online] Tremblay RE, Boivin M, De V, Peters R, editor. Montreal: Centre of Excellence for Early Childhood Development and Strategic Knowledge Cluster on Early Child Development; 2011. FASD: Prevention and nutrition: Commentary on Floyd, Denny and Weber, and Nguyen and Thomas; pp. 1–5.
    1. Andréasson S, Hjalmarsson K, Rehnman C. Implementation and dissemination of methods for prevention of alcohol problems in primary health care: a feasibility study. Alcohol Alcohol. 2000;35(5):525–530. doi: 10.1093/alcalc/35.5.525.
    1. Babor TE, Higgins-Biddle J, Dauser D, Higgins P, Burleson JA. Alcohol screening and brief intervention in primary care settings: implementation models and predictors. J Stud Alcohol. 2005;66(3):361.
    1. Mengel MB, Searight HR, Cook K. Preventing alcohol-exposed pregnancies. J Am Board Fam Med. 2006;19:494–505. doi: 10.3122/jabfm.19.5.494.
    1. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro M. AUDIT – the Alcohol Use Disorder Identification Test: Guidelines for use in Primary Health Care. 2. Switzerland: World Health Organization, Department of Mental Health and Substance Abuse, Geneva; 2001. WHO/MSD/MSB/01.6a.
    1. Floyd RL, Sobell M, Velasquez MM, Ingersoll K, Nettleman M, Sobell L, Mullen PD, Ceperich S, Von Sternberg K, Bolton B, Skarpness B, Nagaraja J. Preventing alcohol-exposed pregnancies: a randomized controlled trial. Am J Prev Med. 2007;32:1–10.
    1. Balachova TN, Bonner BL, Isurina GL, Tsvetkova LA. Use of focus groups in developing FAS/FASD prevention in Russia. Subst Use Misuse. 2007;42:881–894. doi: 10.1080/10826080701202601.
    1. Babor TF, Higgins-Biddle JC. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care. Geneva: WHO; 2001.
    1. Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change. 2. New York: Guilford Press; 2002.
    1. Balachova T, Bonner B, Isurina G, Palchik A, Shapkaitz V, Tsvetkova L. Changing physicians’ knowledge, skills and attitudes to prevent FASD in Russia. Proceedings of the 33rd Annual Scientific Meeting of the Research Society on Alcoholism, Alcoholism: Clinical & Experimental Research. 2010;34(Suppl 6):210A.
    1. Shapkaitz V, Balachova TN, Regentova A. Как выбрать контрацептив [How to choose a contraception method] St. Petersburg: SPSU-OUHSC-NNSPU; 2009. (in Russian)
    1. Pbert L, Fletcher K, Flint A, Young M, Druker S, DiFranza J. Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews. Pediatrics. 2006;118:e810–e824. doi: 10.1542/peds.2005-2869.
    1. Franco LM, Franco C, Kumwenda N, Nkhoma W. Methods for assessing quality of provider performance in developing countries. Int J Qual Health Care. 2002;14(Suppl 1):17–24.
    1. Babor TF, Higgins-Biddle JC, Higgins PS, Gassman RA, Gould BE. Training medical providers to conduct alcohol screening and brief interventions. Subst Abus. 2004;25(1):17–26. doi: 10.1300/J465v25n01_04.
    1. D’Onofrio G, Nadel ES, Degutis LC, Sullivan LM, Casper K, Bernstein E, Samet JH. Improving emergency medicine residents’ approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002;40(1):50–62. doi: 10.1067/mem.2002.123693.
    1. Sukhanova LP. Статистика родовспоможения как фактор обеспечения качества акушерской и перинатальной помощи в России. [Statistics of obstetric aid as a factor of providing quality of obstetric and perinatal care in Russia] Inf Anal Rep Soc Aspects Public Health. 2008. (in Russian)

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren