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Kaufman CE, Asdigian NL, Reed ND, Shrestha U, Bull S, Begay RL, Shangreau C, Howley CT, Vossberg RL, Sarche M. A virtual randomized controlled trial of an alcohol-exposed pregnancy prevention mobile app with urban American Indian and Alaska Native young women: Native WYSE CHOICES rationale, design, and methods. Contemp Clin Trials 2023; 128:107167. [PMID: 37001855 PMCID: PMC10290431 DOI: 10.1016/j.cct.2023.107167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorders (FASD) result in lifelong disability and are a leading cause of preventable birth defects in the US, including for American Indian and Alaska Natives (AIANs). Prevention of alcohol exposed pregnancies (AEPs), which can cause FASD, is typically aimed at adult women who are risky drinkers and have unprotected sex. Among AIANs, AEP prevention research has been primarily conducted in reservation communities, even though over 70% of AIANs live in urban areas. Culturally appropriate AEP prevention for urban AIAN young women, regardless of current drinking or sexual behaviors, may maximize the potential for primary prevention at the beginning of the reproductive years for this underserved population. METHODS We developed a virtual randomized controlled trial (RCT) - fully implemented through technology - to evaluate Native WYSE CHOICES, a culturally tailored mobile app, with urban AIAN young women ages 16-20 nationally. While virtual RCTs are not new, this is the first engaging a solely urban AIAN population, historically excluded from research. Participants are recruited on a rolling basis through the project social media community, organizational partnerships, and in-person events. Eligible participants complete a baseline survey and are randomized to either the app's intervention or comparison arm - each of which provide about 3 h of content. Follow-up data are collected at 1-, 6-, and 12-months post-baseline. RESULTS Our study offers a template for building trust and extending reach to this underserved population while also providing important lessons and insights on advances in virtual or hybrid research approaches.
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Affiliation(s)
- Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nancy L Asdigian
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nicole D Reed
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Umit Shrestha
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Sheana Bull
- mHealth Impact Lab, Department of Community and Behavioral Health, Colorado School of Public Health, Mail Stop F802, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Rene L Begay
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Carly Shangreau
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Caitlin Trucksess Howley
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Raeann L Vossberg
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Michelle Sarche
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
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Smith L, Hilton A, Walker J, Alfred L, Ahankari A, Schölin L. Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers. DIALOGUES IN HEALTH 2022; 1:100040. [PMID: 38515881 PMCID: PMC10953971 DOI: 10.1016/j.dialog.2022.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 03/23/2024]
Abstract
Objective To understand the perspectives of healthcare practitioners and women of reproductive age regarding addressing prevention of an alcohol exposed pregnancy before conception. Methods A scoping review of mixed methods, qualitative and quantitative research was conducted. Medline, CINAHL, EMBASE and PsychInfo databases were searched for literature published by March 2022. Data were extracted and synthesized. Results Twenty-three studies were included. Views varied between healthcare practitioners and women about addressing alcohol with women before pregnancy. Healthcare practitioners agreed prevention was important but believed they were ill-prepared to provide support, and that it might be intrusive if women were not contemplating pregnancy. Whereas women would welcome advice from healthcare practitioners, particularly if offered during appointments or visits for services related to reproductive health. A knowledge deficit about pregnancy and fetal harms from alcohol was expressed by both healthcare practitioners and women. Conclusions Investment in alcohol education and skills training for healthcare professionals is required to ensure a coherent message is communicated across services, and that shared decision making about healthcare between service users and health professionals is facilitated. Future research should explore implementation of interventions to prevent alcohol exposed pregnancy in settings where women are seeking reproductive health support.
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Affiliation(s)
- Lesley Smith
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Andrea Hilton
- Department of Paramedical, Perioperative and Advanced Practice, University of Hull, Hull, UK
| | - Jayne Walker
- Department of Paramedical, Perioperative and Advanced Practice, University of Hull, Hull, UK
| | - Lolita Alfred
- Department of Nursing, City, University of London, London, UK
| | - Anand Ahankari
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
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Hanson JD, Weber TL, Shrestha U, Bares VJ, Seiber M, Ingersoll K. Acceptability of an eHealth Intervention to Prevent Alcohol-Exposed Pregnancy Among American Indian/Alaska Native Teens. Alcohol Clin Exp Res 2020; 44:196-202. [PMID: 31693195 PMCID: PMC6980937 DOI: 10.1111/acer.14229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A tribally led Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) Program has successfully decreased the risk of alcohol-exposed pregnancies (AEPs) among adult American Indian/Alaska Native (AI/AN) women by either reducing risky drinking or increasing contraception use. However, a community needs assessment revealed a need to implement a similar intervention with AI/AN teens. The goal of the project was to develop and establish the acceptability of CHOICES for AI/AN teens. METHODS Key informant interviews were conducted to review the existing OST CHOICES intervention. After modifications to the existing program, focus groups with AI/AN teens were conducted to ensure validity and to finalize the OST CHAT (CHOICES for American Indian Teens) intervention. RESULTS Key informant (N = 15) participants suggested that a Web-based intervention may increase teen engagement by making the intervention more interactive and visually stimulating. Based on this formative research, CHAT was developed via Research Electronic Data Capture (REDCap). Feedback on the online CHAT curriculum was given by focus groups comprised of AI/AN adolescents, and participants felt that this type of intervention would be both acceptable and able to implement with a community of reservation-based teens. CONCLUSIONS This study outlines the development of a Web-based intervention for an AEP intervention for AI/AN teens and will inform future prevention efforts. Implications include an expansion of the evidence-based CHOICES intervention for AI/AN teens and also development of a Web-based intervention for rural, reservation-based AI/AN communities.
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Affiliation(s)
| | | | | | | | | | - Karen Ingersoll
- University of Virginia School of Medicine, Charlottesville, VA USA
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Shrestha U, Hanson J, Weber T, Ingersoll K. Community Perceptions of Alcohol Exposed Pregnancy Prevention Program for American Indian and Alaska Native Teens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1795. [PMID: 31117177 PMCID: PMC6572356 DOI: 10.3390/ijerph16101795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 12/14/2022]
Abstract
A community needs assessment during a tribally-led Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) intervention highlighted the need to reduce the risk for alcohol exposed pregnancy (AEP) among American Indian and Alaska Native (AIAN) adolescent girls. The CHOICES for American Indian Teens (CHAT) Program aims to reduce the risk of AEP among AIAN teens in one Northern Plains tribal community. The CHAT team adopted an iterative process to modify the tribally-led CHOICES curriculum for AIAN teens. This paper describes the iterative process as well as the community perception towards AEP prevention among AIAN teens. The CHAT team conducted several levels of formative and qualitative research, including one-on-one interviews (n = 15) with community members, AIAN elders and school counsellors; and three focus groups with AIAN adolescent girls (n = 15). A qualitative data analysis identified several recommendations that centered on making the information regarding alcohol and birth control appealing to teens; ensuring the confidentiality of the participants; making the program culturally relevant; and including boys in the program. This study outlines various components prioritized by community members in creating a culturally-relevant and age-appropriate AEP prevention program and provides community perceptions of AEP prevention for the teens in this community.
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Affiliation(s)
- Umit Shrestha
- Department of Community and Behavioral Health, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO 80045, USA.
| | - Jessica Hanson
- Behavioral Sciences, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD 57104, USA.
| | - Tess Weber
- Behavioral Sciences, Sanford Research, 2301 East 60th Street North, Sioux Falls, SD 57104, USA.
| | - Karen Ingersoll
- University of Virginia School of Medicine, 310 Old Ivy Way, Charlottesville, VA 22903, USA.
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Kelley A, Witzel M, Fatupaito B. Preventing Substance Use in American Indian Youth: The Case for Social Support and Community Connections. Subst Use Misuse 2019; 54:787-795. [PMID: 30574816 DOI: 10.1080/10826084.2018.1536724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS This study explored the relationship between social support, community connections, self-esteem, and culture on misuse in American Indian youth. METHODS The study team developed a culturally-responsive 16-question survey for American Indian youth ages 12-20 living in six American Indian communities in the Great Plains Region of the United States. The study was grounded in primary socialization theory and variables were explored using regression models. RESULTS A total of 565 American Indian youth completed the participant survey between January 2016 and August 2017. The present study found that community connections were negatively associated with marijuana use in American Indian youth. Higher community connection scores were associated with higher social support and self-esteem scores. CONCLUSIONS Tribally-led prevention initiatives can fill an important socio-behavioral prevention gap by facilitating social support opportunities for American Indian youth who may not have adequate support from immediate family or friends.
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Affiliation(s)
- Allyson Kelley
- a Allyson Kelley & Associates PLLC , Sandia Park , New Mexico , USA
| | - Morgan Witzel
- b Rocky Mountain Tribal Leaders Council , Billings , Montana , USA
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Hanson JD, Pourier S. The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010001. [PMID: 26703670 PMCID: PMC4730392 DOI: 10.3390/ijerph13010001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022]
Abstract
Alcohol-exposed pregnancies are a health issue for many American Indian communities. The goal of this manuscript is to outline how an existing alcohol-exposed pregnancy prevention program with non-pregnant women (Project CHOICES) was modified to fit the needs and norms of an American Indian community. The Oglala Sioux Tribe CHOICES Program was developed and implemented using community feedback through initial meetings, reviewing materials, gathering input into recruitment and intervention logistics, and conducting interviews to evaluate the program. The intervention was implemented and has been enrolling non-pregnant American Indian women for the past several years. While data collection is ongoing, it has shown preliminary success in changing behaviors and in impacting how the community views the prevention of alcohol-exposed pregnancies. Overall, this study highlights the potential to expand this prevention program to other sites and with other populations, such as adolescents. By the end of this article, readers will comprehend the steps necessary to replicate such a program at other tribal and rural sites.
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Affiliation(s)
- Jessica D Hanson
- Sanford Research, 2301 E. 60th St North, Sioux Falls, SD 57104, USA.
| | - Susan Pourier
- OST CHOICES Program, PO Box 824, Pine Ridge, SD 57770, USA.
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