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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Drinking During Pregnancy.

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Strategy. Motivational Interviewing

Approach. Facilitate motivational interviewing techniques that encourage women who are, or may become, pregnant recognize and change risk behaviors associated with alcohol-exposed pregnancies.

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Overview. Motivational interviewing. (MI) has been shown to be an effective method for reducing and abstaining from harmful substances, with the strongest evidence towards tobacco and alcohol use.[1] Whether used as a primary strategy or in tandem with other preventive measures, MI can effectively guide women to recognize and change risk behaviors associated with alcohol exposed pregnancies. Both in-person interviewing and online interactive interviewing appear to be effective in reducing the rate of alcohol use during pregnancy.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Counseling (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of providers trained in motivational interviewing for preventing alcohol-exposed pregnancies. (Measures workforce skills development) Number of programs incorporating motivational interviewing into alcohol screening protocols. (Assesses adoption of the technique)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of training participants demonstrating proficiency in motivational interviewing skills. (Evaluates quality of workforce preparation) Percent of sessions adhering to best practice guidelines for motivational interviewing. (Assesses fidelity of intervention delivery)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of individuals completing motivational interviewing sessions focused on alcohol use and reproductive health who report an increase in knowledge and/or skill. (Indicates engagement in intervention) Number of individuals identifying goals to reduce alcohol-related pregnancy risk through motivational interviewing. (Demonstrates personalized planning) Number of individuals reporting increased use of effective contraception to prevent unintended alcohol-exposed pregnancies. (Assesses behavioral risk reduction) Number of alcohol-free pregnancies among individuals who previously drank while pregnant. (Measures impact in population facing higher health risks)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of individuals completing motivational interviewing sessions focused on alcohol use and reproductive health who report an increase in knowledge and/or skill. (Indicates engagement in intervention) Percent of individuals identifying goals to reduce alcohol-related pregnancy risk through motivational interviewing. (Demonstrates personalized planning Percent of individuals reporting increased use of effective contraception to prevent unintended alcohol-exposed pregnancies. (Assesses behavioral risk reduction) Percent of alcohol-free pregnancies among individuals who previously drank while pregnant. (Measures impact in population facing higher health risks)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Linder, SL, Masciolam R (2023). Promoting mental self-care strategies during pregnancy and postpartum with motivational interviewing. Women’s healthcare 11(3)20-25.

[2] Ingersoll, K., Frederick, C., MacDonnell, K., Ritterband, L., Lord, H., Jones, B., & Truwit, L. (2018). A Pilot RCT of an Internet Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy. Alcoholism, clinical and experimental research, 42(6), 1132–1144.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.