title: Feasibility and promise of a remote-delivered preconception motivational interviewing intervention to reduce risk for alcohol-exposed pregnancy.
abstract: BACKGROUND
  Alcohol-exposed pregnancy (AEP) is a leading cause of birth defects. Effective face-to-face preconception interventions based on motivational interviewing (MI) exist and should be translated into remote formats for maximum public health impact. This study investigated the feasibility and promise of a one-session, remote-delivered, preconception, MI-based AEP intervention (EARLY Remote) for non-treatment-seeking community women.
  
  
  METHODS
  This was a single-arm, prospective pilot intervention study. All participants received the intervention via telephone and mail. Feasibility of remote-delivery methods, treatment engagement, treatment credibility, MI treatment integrity, and therapeutic alliance were examined. Outcomes were 3- and 6-month drinks per drinking day (DDD), rate of unreliable contraception, and proportion of women at risk for AEP due to continued risk drinking and no or unreliable contraception use.
  
  
  RESULTS
  Feasibility of remote delivery was established; participants were engaged by the intervention and rated it as credible. Integrity to MI and therapeutic alliance were good. Both DDD and rate of unreliable contraception decreased significantly over time. Proportions of women who drank at risk levels, used unreliable or no contraception, and/or were at risk for AEP in the past 90 days decreased significantly from baseline to 6 months.
  
  
  CONCLUSIONS
  Remote delivery was feasible, and the translated remote intervention may reduce AEP risk. Refinement of EARLY Remote may facilitate its placement within a spectrum of effective MI-based preconception AEP interventions as part of a stepped-care approach. EARLY Remote may have an important role within a stepped-care model for dissemination to geographically disperse women at risk for AEP. This could result in substantial public health impact through reduction of AEP on a larger scale.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia , Charlottesville, VA 22911, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Farrell-Carnahan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hettema
authors.forename: Justin
authors.initials: J
authors.lastname: Jackson
authors.forename: Shivi
authors.initials: S
authors.lastname: Kamalanathan
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
authors.forename: Karen S
authors.initials: KS
authors.lastname: Ingersoll
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000517:prevention & control*; D006801:Humans; D062405:Motivational Interviewing / Q000379:methods / Q000458:organization & administration*; D010865:Pilot Projects; D011177:Postal Service; D016742:Preconception Care; D011247:Pregnancy; D011446:Prospective Studies; D013685:Telecommunications; D014768:Virginia; D055815:Young Adult