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Prenatal Care: Health in Pregnancy and Keep Fit Projects

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Prenatal Care: Health in Pregnancy and Keep Fit Projects

Our study of prenatal health care professionals (see Seizing the 9-month moment) highlighted how regular prenatal visits offer opportunities to deliver and reinforce risk-reduction messages regarding substance use (including tobacco, alcohol, and illicit drugs) and intimate partner violence (IPV). Because health care professionals may lack time, comfort, and/or skill to conduct these efforts, innovative approaches are needed to capitalize on these opportunities. Computer programs are increasingly used to assess patient risks and deliver individualized preventive interventions. Over a series of studies, we have used a multimedia intervention delivered by an actor-portrayed “video doctor” programmed to respond to participant input. The intervention capitalizes on physicians' credibility, simulating a live interview.

Health in Pregnancy (HIP) is a randomized, controlled trial to determine if a brief, interactive, multimedia intervention for pregnant women can reduce their risks related to smoking, alcohol, illicit drug use, and IPV.

Pregnant patients who receive prenatal care at one of the study sites use a touchscreen laptop computer to complete the HIP risk assessment immediately prior to a regularly scheduled prenatal appointment. Privacy is assured by use of a private examination room and headphones. Women who report one or more of the four risks are instantaneously randomized to the intervention or control group.

For those women randomized to the intervention group, upon completion of the risk assessment the HIP program seamlessly transitions to the Video Doctor. (Those women who do not have the risks assessed in HIP are randomly assigned to the intervention or control group of the secondary HIP-Keep Fit study (see HIP-Keep Fit.)) An actor-portrayed Video Doctor delivers interactive risk-reduction messages, designed to simulate an ideal discussion with a prenatal health care provider. Using a library of digital video clips, extensive branching logic, and participant input, the program tailors messages to the participant’s risk profile and readiness to change. At the conclusion of each intervention session, the program automatically prints 2 documents: 1) an “Educational Worksheet" for participants with questions for self-reflection, harm reduction tips, and local resources; and 2) a “Cueing Sheet” for providers, which offers a summary of the patient’s risk profile and suggests risk-reduction counseling statements. The Cueing Sheet is placed in the patient’s medical record for the provider’s use during the prenatal appointment.

The assessment component of the computer program is presented to all participants over three prenatal visits. Intervention participants receive an additional 10–15 minutes of “booster” Video Doctor counseling at their second prenatal visit. Women assigned to the control group receive the usual care offered by their health care setting. (Click here for visual of the HIP study design.)

To determine the effect of the HIP program on patients’ risks, we will compare self-reported risks and readiness to change at baseline and at the final intervention session. While it is ambitious to tackle multiple behaviors, the study addresses a reality: prenatal health care professionals often address several behavioral areas at once in order to help a woman make a significant change in her life.

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Page last updated October 27, 2009