Prevention for Prenatal Health

描述(由申请人提供)：定期产前检查提供机会，传递和加强关于物质使用(包括烟草、酒精和非法药物)和亲密伴侣暴力(IPV)的风险降低信息。由于卫生保健提供者可能缺乏时间、舒适度和/或技能来进行这些努力，因此需要创新的方法来利用这些机会。计算机程序越来越多地被用来评估患者风险并提供个性化的预防干预。我们建议进行一项随机对照试验，以确定对孕妇的简短、互动、多媒体干预是否可以：1)提高患者与提供者讨论吸烟、酒精、非法药物使用和IPV相关风险的频率；2)降低女性与这些主题相关的风险。为了利用医生的可信度，多媒体干预将由一名演员扮演的“视频医生”提供，该视频医生被编程为对参与者的输入做出反应，模拟现场采访。在三个研究地点中的一个地点接受产前护理的会说英语或西班牙语的孕妇将由“视频护士”对药物使用和IPV风险进行筛查。报告四种风险中的一种或多种的450名孕妇将被随机分配到干预组或对照组。干预组患者将接受产前预防健康干预，包括由“视频医生”演示的多媒体简短干预和提供者警报。该多媒体节目将在四次产前访问中展示，并将根据患者的风险和对变化的准备情况量身定做。提供者警报，详细说明参与者的风险并建议适当的干预措施，将在每次治疗后立即放入患者的医疗记录中，供产前保健提供者在妇女定期预约期间使用。被分配到控制组的妇女将得到在其卫生保健环境中提供的通常护理。为了确定产前预防健康干预对患者-提供者讨论和患者风险的影响，我们将比较基线和最终干预阶段的自我报告的讨论、风险和改变的准备情况。我们预计，与控制组中的类似参与者相比，干预组的参与者在患者与提供者的讨论中将显着增加，并准备改变他们的风险行为，而在风险行为方面则有所减少。

DESCRIPTION (provided by applicant): 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 providers 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. We propose to conduct a randomized, controlled trial to determine if a brief, interactive, multimedia intervention for pregnant women can 1) improve the frequency of patient-provider discussions regarding risks related to smoking, alcohol, illicit drug use, and IPV; and 2) reduce women's risks related to these topics. To capitalize on physicians' credibility, the multimedia intervention will be delivered by an actor-portrayed "video doctor" programmed to respond to participant input, simulating a live interview. Pregnant women who speak English or Spanish and who receive prenatal care at one of the three study sites will be screened by a "video nurse" for substance use and IPV risks. Four hundred and fifty pregnant women who report one or more of the four risks will be randomly assigned to an Intervention or a Control Group. Intervention Group patients will receive the Prenatal Preventive Health Intervention, consisting of a multimedia brief intervention presented by a "video doctor" and a provider alert. The multimedia program will be presented over four prenatal visits and will be tailored to patients', risks and readiness to change. The provider alert, detailing participants' risks and suggesting appropriate interventions, will be placed in patients' medical records immediately following each session for use by prenatal health care providers during the woman's regular appointment. Women assigned to the Control Group will receive the usual care offered in their health care settings. To determine the effect of the Prenatal Preventive Health Intervention on patient-provider discussions and patients' risks, we will compare self-reported discussions, risks, and readiness to change at baseline and at the final intervention session. We expect that participants in the Intervention Group will show significant increases in patient-provider discussions and readiness to change their risk behaviors and reductions in risk behaviors compared with similar participants in the Control Group.