title: The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women.
abstract: BACKGROUND
  African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format.
  
  
  METHODS
  Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported.
  
  
  RESULTS
  Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended > or = 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were fully completed (where all required risk content was covered). Ninety-three percent of the subsample of intervention women had a positive view of their relationship with their counselor. Most intervention women found the session content helpful. Implementation challenges of addressing multiple risk behaviors are discussed.
  
  
  CONCLUSIONS
  While implementation adjustments and flexibility are necessary, multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services, and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions.
authors.affiliation: Department of Pediatrics, Georgetown University Medical Center, 2201 Wisconsin Ave NW, Suite 220, Washington, DC 20007, USA. katzk@georgetown.edu
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Katz
authors.forename: Susan M
authors.initials: SM
authors.lastname: Blake
authors.forename: Renee A
authors.initials: RA
authors.lastname: Milligan
authors.forename: Phyllis W
authors.initials: PW
authors.lastname: Sharps
authors.forename: Davene B
authors.initials: DB
authors.lastname: White
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Rodan
authors.forename: Maryann
authors.initials: M
authors.lastname: Rossi
authors.forename: Kennan B
authors.initials: KB
authors.lastname: Murray
mesh_terms: D000328:Adult; D001741:Black or African American; D003376:Counseling / Q000379:methods* / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration*; D003863:Depression / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D017060:Patient Satisfaction; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D016540:Smoking Cessation / Q000379:methods; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000517:prevention & control; D013315:Stress, Psychological / Q000453:epidemiology / Q000517:prevention & control; D014028:Tobacco Smoke Pollution / Q000517:prevention & control / Q000706:statistics & numerical data; D014481:United States; D014504:Urban Health
chemical_list: D014028:Tobacco Smoke Pollution