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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. Integrated Behavioral Intervention

Approach. Combine motivational interviewing with cognitive-behavioral strategies that focus on the adoption of both effective contraception and the reduction of alcohol use in communities where women are at high risk for alcohol-exposed pregnancies

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Overview. Alcohol exposed pregnancy. (AEP) prevention programs that combine contraception counseling with in-person brief interventions and motivational interviewing sessions have proven successful in reducing alcohol consumption among non-pregnant women who may experience AEP.[1,2,3] This strategy has been successfully adapted to reduce alcohol consumption among women in indigenous communities, where members of the community and local clinicians are recruited to participate in the process. This strategy has been well received by women at risk for AEP and the results have been positive. Studies of the effectiveness of this strategy are ongoing.[4,5]

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).
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

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

Intervention Level. Community-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 to deliver integrated motivational interviewing and cognitive-behavioral interventions for reducing alcohol-exposed pregnancy risk. (Measures workforce development) Number of women who receive motivational interviewing sessions that incorporate cognitive-behavioral strategies for family planning and reducing alcohol use. (Shows program reach)

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

  • Percent of providers trained to deliver integrated motivational interviewing and cognitive-behavioral interventions for reducing alcohol-exposed pregnancy risk. (Measures workforce development) Percent of women who receive motivational interviewing sessions that incorporate cognitive-behavioral strategies for family planning and reducing alcohol use. (Shows program reach)

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

  • Number of providers who demonstrate competency in delivering the integrated intervention after completing training. (Assesses workforce preparedness) Number of integrated motivational interviewing and cognitive-behavioral sessions that adhere to the specified protocols and quality standards. (Measures fidelity of implementation) Number of repeat alcohol-exposed pregnancies prevented among women who previously delivered an alcohol-affected baby. (Estimates impact in a focus group) Number of children born without fetal alcohol spectrum disorders in communities implementing the integrated prevention strategy. (Shows ultimate outcome of interest)

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

  • Percent of providers who demonstrate competency in delivering the integrated intervention after completing training. (Assesses workforce preparedness) Percent of integrated motivational interviewing and cognitive-behavioral sessions that adhere to the specified protocols and quality standards. (Measures fidelity of implementation) Percent of repeat alcohol-exposed pregnancies prevented among women who previously delivered an alcohol-affected baby. (Estimates impact in a focus group) Percent of children born without fetal alcohol spectrum disorders in communities implementing the integrated prevention strategy. (Shows ultimate outcome of interest)

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] Floyd, R. L., Sobell, M., Velasquez, M. M., Ingersoll, K., Nettleman, M., Sobell, L., Mullen, P. D., Ceperich, S., von Sternberg, K., Bolton, B., Johnson, K., Skarpness, B., Nagaraja, J., & Project CHOICES Efficacy Study Group (2007). Preventing alcohol-exposed pregnancies: a randomized controlled trial. American journal of preventive medicine, 32(1), 1–10.

[2] Hanson, J. D., & Pourier, S. (2015). 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, 13(1), ijerph13010001.

[3] Hanson, J. D., Nelson, M. E., Jensen, J. L., Willman, A., Jacobs-Knight, J., & Ingersoll, K. (2017). Impact of the CHOICES Intervention in Preventing Alcohol-Exposed Pregnancies in American Indian Women. Alcoholism, clinical and experimental research, 41(4), 828–835.

4] Hanson, J. D., Oziel, K., Sarche, M., MacLehose, R. F., Rosenman, R., & Buchwald, D. (2021). A culturally tailored intervention to reduce risk of alcohol-exposed pregnancies in American Indian communities: Rationale, design, and methods. Contemporary clinical trials, 104, 106351.

[5] Background] Kaufman, C. E., Asdigian, N. L., Reed, N. D., Shrestha, U., Bull, S., Begay, R. L., Shangreau, C., Howley, C. T., Vossberg, R. L., & Sarche, M. (2023). 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. Contemporary clinical trials, 128, 107167.

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.