Kathy S. Katz

Retention of low income mothers in a parenting intervention study

Women with inadequate prenatal care were recruited to a multi-component parenting intervention study. Because it was anticipated that this high-risk population might present challenges to retention, a variety of strategies were employed to maintain their participation in the study. This report reviews the results of these retention efforts and compares the population that completed the study versus those that terminated prior to study completion. Two hundred and eighty-six women were randomized to an intervention or control group. Careful tracking of the mothers, offering incentives for completing various study activities and providing a culturally competent staff were among the strategies employed to maintain participation. Comparison was made of those mothers terminating before study completion versus those retained, and of those terminating early in the study period versus later. Despite retention efforts, attrition at a level of 41% occurred. A few characteristics of mothers terminating early from the study were significant including older maternal age, a larger number of children, and incidence of no prenatal care. Despite comprehensive tracking procedures, some mothers were lost to follow up after change of residence. Other reasons for attrition included child outplacement and refusal of services or data collection procedures.

The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women

BackgroundAfrican 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.MethodsSix 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.ResultsForty-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 ≥ 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.ConclusionWhile 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.

Developing a shared language: interdisciplinary communication among diverse health care professionals.

Multidisciplinary teams of nurses, physicians, and other professionals may have difficulty communicating because of inconsistent theoretical underpinnings. A theoretical base that spans both clinical outcomes and professional boundaries is needed. The web of causation is a theoretical framework that provides a platform of communication connecting issues related to infant mortality among various health-related professions. It includes professional, community, and institutional issues relevant to pregnant women and new mothers as infant caregivers. The article discusses how the web was used for interdisciplinary health care professional interaction and how it was used to develop a series of research protocols that will affect the care of mothers and infants in the District of Columbia.

Achieving Success in Poor Urban Minority Community-Based Research: Strategies for Implementing Community-Based Research Within an Urban Minority Population

Various models of community research have been employed to assess community health needs and address community health problems. Infant mortality remains a problem in urban minority communities throughout the United States. This article compares various community research models with a three-tiered community involvement model used in Washington, D.C., an urban, predominantly African American community with one of the worst rates of infant mortality in the nation. The research design incorporated community input throughout the research design process, resulting in a better understanding of issues and problems associated with infant mortality within the community setting. The use of the model improved community participation in the research process, facilitating improved health initiatives.

A Community-Based Intervention Improves Preventive Health Care Utilization and Immunization Rates for a High Risk DC Population

A Community-Based Intervention Improves Preventive Health Care Utilization and Immunization Rates for a High Risk DC Population

Poor Prenatal Care Utilization in a Population of DC Residents Correlates with Their Health Beliefs † 1244

261 DC residents were identified in their post partum period as having used prenatal care poorly during pregnancy (defined as < 5 visits and/or care initiated after 24 weeks gestation). Of the mothers who received prenatal care, 31% received care with a private physician, 37% in a hospital based clinic, 20% in a public clinic, and 2% listed the ER as where they received care; 11% had received no prenatal care. When interviewed, 93% agreed that prenatal care was important, yet 56% had not initiated care until the third trimester, and 76% until the second trimester of pregnancy. Mean number of prenatal care visits was 3.7 ± 2.7, and time of initiating prenatal care was 26 ± 7 weeks gestation. The top four reasons listed for non-adherence to prenatal care schedule were lack of funds (19%), transportation difficulties (12%), the baby being in good health (7%), and lack of child care (7%). When the Health Beliefs Questionnaire was administered to these mothers, although their perception of severity of illness was relatively higher (79/96), their perception of susceptibility to illness (28/46), and efficacy of medical care (27/48) were relatively low. These findings suggest that although mothers with poor prenatal care express practical difficulties as barriers to seeking care, underlying beliefs about susceptibility to illness and the efficacy of medical care also impact on their behaviors.

SUBSTANCE ABUSE IS A SIGNIFICANT MARKER FOR PERINATAL MORBIDITY IN A POPULATION OF WOMEN WITH POOR PRENATAL CARE IN WASHINGTON † 1560

Poor prenatal care (PNC) is an important risk factor for perinatal morbidity. This study defines the additive risk of substance abuse (SA) during pregnancy in a population of 480 D.C. residents with no/poor PNC. Poor PNC was identified if care was initiated after 24 weeks, or less than 5 visits. 35% of these post partum women showed evidence of substance abuse during pregnancy by history and/or urine testing. The two groups are compared below (results expressed as mean ±S.E.M.) The relative risk (RR) for prematurity in women with SA and no/poor PNC was 2.7, (95% C.I. = 1.6-3.8, p<0.0001). The attributable risk fraction (ARF) for LBW associated with SA in this population was 31%. The RR for LBW in women with SA and no/poor PNC was 2.6 (95% C.I. = 1.5-3.63, p<0.0001). The ARF for prematurity associated with SA in this population was 32%. We conclude that women with no/poor PNC who abuse substances during pregnancy are at exquisitely high risk for poor outcomes and deserve to be targeted specifically in programs designed to reduce perinatal/neonatal morbidity and mortality. Table