Developing Educational Materials for Prevention of FAS/FASD in - - PowerPoint PPT Presentation

Developing Educational Materials for Prevention of FAS/FASD in Russia

Barbara L. Bonner, PhD Tatiana Balachova, PhD Center on Child Abuse and Neglect University of Oklahoma Health Sciences Center AUCD Webinar January 15, 2008

University of Oklahoma Health Sciences Center in Collaboration with

• St. Petersburg State University

Phase I: Preventing FAS/ARND in Russian Children funded by NIH Fogarty International Center, 2003-2007 Phase II: Development of Education Materials for Prevention of FAS in Russia, funded by AUCD/CDC, 2005-2008 Phase III: Preventing FAS/ARND in Russian Children, funded by NIH and NIAAA 2007-2012; Health of Children in Russia: Providing Education on FAS/FASD, funded by AUCD/CDC, 2007-2008

Project Team

OUHSC Barbara Bonner, PhD Tatiana Balachova, PhD Karen Beckman, MD Mark Chaffin, PhD John Mulvihill, MD Mark Wolraich, MD David Bard, MS

SPSU

Larissa Tsvetkova, PhD Alexander Palchick, MD, PhD, Academy of Pediatrics Vladimir Shapkaitz, MD, PhD, Academy of Pediatrics Galina Isurina, PhD Elena Volkova, PhD, Nizhny Novgorod Pedagogical Academy Max Gusev Alla Ioffe Maria Potapova Olga Glusdova, PhD Data Collectors in St. Petersburg and Nizhny Novgorod Consultants Edward Riley, PhD, San Diego State University Linda Sobell, PhD, Nova Southeastern University Jacquelyn Bertrand, PhD, CDC Oleg Erishev, MD, PhD, Bekterev Institute, St. Petersburg Corinne Reinicke, MD, WHO, Moscow (2007) Mark Mengel, MD, MPH, University of Arkansas Danny Wedding, PhD, University of Missouri Kevin Rudeen, Ph.D, OUHSC Michael Fleming, MD, MPH, University of Wisconsin

Alcohol consumption in Russia

Russia:

• One of highest levels of alcohol consumption and burden of disease

attributed to alcohol in world (WHO, 2005)

• Most hazardous patterns
• f consumption with

traditionally frequent and heavy drinking patterns in men (Bobak et al., 1999)

• Increasingly hazardous

drinking in young women (Hibell et al., 2004)

Estimated adult alcohol consumption per person per year (WHO, 2005)

Phase I

Objective Assess knowledge, attitudes, drinking behaviors, and receptivity to prevention necessary for developing a FAS/ARND primary prevention program in Russia.

Phase I: Study Design

Sample

Focus groups: 7 groups, N=51 Survey with 851 participants from St.

Petersburg and the Nizhniy Novgorod region

– 648 women recruited at women’s clinics:

301 pregnant and 347 non-pregnant

– 203 physicians recruited at continuing

education courses: 100 OBGs and 103 pediatricians

Phase I: Women’s reported drinking

20 88 92

10 55

10 20 30 40 50 60 70 80 90 100 Pregnant Trying to get pregnant* Might become pregnant

% women reported, Russia % women reported, USA

CDC, 2004 and P-FAS-I study data (* no data for USA) Might become pregnant: RU – one or more unprotected sex in last 6 months

Phase I: Women’s reported binge drinking

2.7 50.5 60.3 1.9 12.4

10 20 30 40 50 60 70 Pregnant Trying to get pregnant* Might become pregnant

% women reported, Russia % women reported, USA

CDC, 2004 and P-FAS-I study data (* no data for USA) Binge drinking: RU - 4 or more drinks on one occasion; US – 5 or more Might become pregnant: RU – one or more unprotected sex in last 6 months

Phase I: Survey of Physicians

10 20 30 40 50 60 70 80 90 OBGs Pediatricians

Always ask non-pregnant about drinking Always ask pregnant about drinking(OBG)/Always ask mothers of infants (Peds) Reported hearing about FAS Occasional alcohol consumption is safe in one of trimesters FAS baby is born with certain birth defects FAS baby is born drunk FAS baby is born addicted to alcohol Acknowledged the lifetime persistence of FAS Agreed that lowered IQ/mental retard. are associated with drinking during pregnancy Advocate complete abstinence for pregnant

Phase I: Conclusions

Alarmingly high levels of drinking and binging

among women who are attempting to or might become pregnant

Most women only vaguely understood the

degree of risk involved

Decline in consumption after pregnancy

recognition is promising for prevention efforts

Phase I: Conclusions

Need to develop education materials

targeting women and their close family members

Interventions delivered by medical

professionals; OBGs in particular, may be influential

Need to develop training materials on

FAS/FASD for Russian physicians

Phase II: Objectives

Develop training materials for health

professionals and information materials targeting women in Russia.

Evaluate materials in randomized trials in a

pre-post test design to determine effectiveness

• f the training and print materials.

Phase II: Curriculum for OBGs (N = 120) (3 hours)

Part 1: FAS foundation Biomedical effects of alcohol on fetus FAS/FADSD diagnosis and screening FAS/FASD treatment across the lifespan and multidisciplinary case management Approaches to prevention Part 2: Risk for AEP and risk groups Screening for women Part 3: Brief intervention Lectures, case examples, discussions, and role plays to address knowledge, attitudes, and skills.

Phase II: Curriculum for Pediatricians (3 hours)

Part 1: FAS foundation Biomedical effects of alcohol on fetus Characteristics of FAS/FASD in infants and across the lifespan Part 2: FAS assessment and diagnosis Part 3: FAS/FASD treatment and multidisciplinary case management Part 4: Prevention of FAS/FASD: screening and brief intervention Lectures, case examples, discussions, and practice to address knowledge, attitudes, and skills

Sample: Physicians (N=120) recruited through the continuing education programs for OBGs and pediatricians at the St. Petersburg Academy for Pediatrics. Procedures: Groups of physicians are randomly assigned to the experimental or control conditions.

Participants in the experimental groups (30 OBGs and 30

pediatricians) received specialized training on FAS; participants in the control groups (30 OBGs and 30 pediatricians) received a regular CE course and both groups received the same number of continuing education hours.

Phase II: Training for Physicians Study Design

Phase II: Development of Materials for Women

Evaluate informational

materials for public that are available in Russia

Select and translate

print materials

– Materials available in US

were reviewed by faculty and 13 print information materials were selected and discussed in focus groups.

FAS and the Brain

How Prenatal Alcohol Exposure Affects Development of the Brain

www.fasstar.com

Phase II: Focus Groups

Focus groups to solicit feedback on the materials and assess women’s preferences. Sample: 35 women of childbearing age in St. Petersburg and Nizhniy Novgorod. Results

• Images and format suggestions:

–

Emotional impact and attention getting

–

Positive images for women who are light drinkers and negative images for heavy drinkers

–

Clear “message”

–

Photos instead of drawings

–

Small size or posters for walls

• Content

–

Specific information

–

Easy to understand for everyone

–

Brief and easy to read, even from glancing

–

Question-answer format

–

Helpful practical advice

Brochures developed

Phase II: Testing Brochures

• 420 women pregnant and non pregnant

randomly assigned Procedure: Randomly assigned to 1 of 3 groups: (1)review the FAS prevention brochure with positive images (N=140), (2)review the FAS prevention brochure with negative images (N=140), and (3)receive health materials that are available at local clinics (N=140).

Phase II: Testing Brochures

– Following the intervention, women complete

a brief questionnaire.

– At a one-month follow-up, women complete

a post-test of self-reported alcohol consumption, knowledge about prenatal effects of alcohol and FAS, and attitudes to drinking during pregnancy.

– Data analysis currently underway

Phase II: Lessons Learned

US professionals highly responsive to requests. Translation continues to be a challenge. – Several steps are necessary: translation,

editing, review by medical faculty, second editing by Russian faculty, editing by US faculty).

Requesting/receiving permissions to translate

materials, including pictures, and requires extensive time.

Phase II: Lessons Learned

Interactive education techniques, such as role plays,

new to Russian education.

– An experienced group trainer was recruited to the

project

– A model situation prepared and video recoded as a

model intervention to demonstrate before practice to reduce anxiety for the project trainees.

International project requires more time for

subcontracts and other grant management issues.

Collaboration involves two IRBs which requires more

time to receive approvals from both.

Phase III: RCT

Testing brief intervention by OBG physicians at

women’s clinics.

N = 700 women who are at risk for AEP Project in initial phase

Conclusions

International research takes extensive time Important to have bilingual staff at both

Universities

Russian faculty, students, physicians, and

clinic staff enthusiastic about research