SBIR Phase II New Risk Assessment/Intervention For Pregnant Woman

吸毒在孕妇中很常见，但估计只有32%到42%的产前护理提供者 例行公事地询问病人他们的药物使用情况。产前检查为提供者提供了一个独特的机会 教育妇女有关预防的知识，并检测怀孕期间的药物使用情况。以促进高效使用 提供者资源，我们开发了一个计算机化的交互式调查访谈，怀孕信息 计划(PIP)已经在非西班牙裔白人、西班牙裔和美国印第安人中进行了广泛的测试 人口。早期的研究表明，PIP在多民族/种族孕妇中很受欢迎 人口。更重要的是，PIP引发了关于吸毒和其他社会问题的更诚实的回应 被污名化的行为比纸质和铅笔问卷要好。在第一阶段，我们更新了程序，集成了 目前的诊断标准，增加了量身定做的动机干预，并纳入了音频和视频 元素添加到程序中。对于这个二期工程，我们建议进一步提升软件能力， 将使用领域扩大到临床医生，并开发出整个光盘的商业质量原型 乐器。我们将在6个社区妇女诊所对完成的仪器进行Beta测试，以确定其 可接受性和易用性，通过匿名的临床医生调查和完成率。我们还将 对346名孕妇进行随机对照临床试验，以确定PIP促进 从怀孕初期到妊娠晚期，行为会发生变化。在本试验中评估的主要结果 包括自我报告的营养、药物使用、酒精使用、吸烟、艾滋病毒危险行为的变化，以及 避免对伴侣的虐待。我们还将评估变革的准备阶段，即尚未变革的阶段。 明示。怀孕前三个月的受试者将随机完成PIP或计算机问卷调查 减去教育和定制的激励反馈。两个小组还将收到打印的 教育信息。在他们怀孕的最后三个月，受试者将完成第二次基于计算机的 问卷来确定当前的行为，并将参加关于他们的个人面试 对PIP的反应。配对数据将使用广义线性混合模型进行分析以估计差异 随着时间的推移，在群体之间和群体内部。这项研究将揭示PIP在促进产前检查方面的潜力 健康的行为，改善生育结果，同时节省提供者的时间。

Drug use is common among pregnant women, yet only an estimated 32% to 42% of prenatal care providers routinely ask patients about their use of drugs. Prenatal visits afford a unique opportunity for providers to educate women about prevention, and to detect drug use during pregnancy. To facilitate efficient use of provider resources, we developed a computerized interactive survey interview, the Pregnancy Information Program (PIP) that has been extensively tested in non-Hispanic white, Hispanic, and American Indian populations. Earlier studies demonstrated that the PIP was well received in multiple ethnic/racial pregnant populations. More importantly, the PIP evoked more honest responses regarding drug use and other socially stigmatized behaviors than paper-and-pencil questionnaires. In Phase I we updated the program, integrated current diagnostic standards, added a tailored motivational intervention, and incorporated audio and video elements to the program. For this Phase II project, we propose to further enhance the software capabilities, expand the domains of use to clinicians, and develop a commercial quality CD ROM prototype of the entire instrument. We will beta test the completed instrument in 6 community women's clinics, to determine its acceptability and ease of use, through anonymous clinician surveys and rates of completion. We will also conduct a randomized, controlled clinical trial of 346 pregnant women to determine PIP's ability to promote behavior change from the initial to the third trimesters of pregnancy. Primary outcomes evaluated in this trial include self-reported changes in nutrition, drug use, alcohol use, cigarette smoking, HIV risk behavior, and partner abuse avoidance. We will also assess stages of readiness to change, where change is not yet manifest. Subjects in their first trimester will be randomized to complete the PIP or a computer questionnaire minus the educational and customized motivational feedback. Both groups also will receive printed educational information. In their third trimesters, subjects will complete a second computer-based questionnaire to determine current behaviors, and will participate in a personal interview regarding their reaction to PIP. Paired data will be analyzed using generalized linear mixed models to estimate differences between and within groups over time. This study will reveal the potential of the PIP to enhance prenatal healthy behaviors, and improve birth outcomes, while saving providers time.