J. Med. Internet Res. - Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial.

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Resumo

CKGROUND: Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode.OBJECTIVE: The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol.METHODS: A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use.RESULTS: Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant.CONCLUSIONS: This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person's anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol.TRIAL REGISTRATION: Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol).

Resumo Limpo

ckground effect intervent need reduc neurobehavior impair children due matern alcohol use pregnanc current healthcounsel intervent shown inconsist result reduc prenat alcohol use thus research use health counsel need gain knowledg effect type intervent reduc alcohol use pregnanc altern promis strategi comput tailor howev date studi shown effect intervent modeobject aim test effect health counsel comput tailor stop reduc matern alcohol use pregnanc dutch sampl pregnant women use alcoholmethod total dutch midwiferi practic random assign condit recruit health counsel comput tailor usual care respond februari septemb healthcounsel respond receiv counsel midwif accord healthcounsel protocol consist step address feedback session computertailor respond receiv usual care midwif computertailor feedback letter via internet usual care respond receiv routin alcohol care midwif month assess effect intervent alcohol useresult multilevel multipl logist regress analys show computertailor respond stop use alcohol often compar usual care respond month baselin vs p multilevel multipl linear regress analys show computertailor respond mean sd unit per week averag p lower p alcohol use pregnanc averag p lower p social support strong reduc alcohol use month baselin compar usual care respond mean sd unit per week six month baselin healthcounsel respond stop use alcohol differ usual care group significantconclus first studi show comput tailor can effect reduc alcohol use pregnanc health counsel effect reduc alcohol use futur research develop healthcounsel intervent reduc alcohol use pregnanc recommend invest recruit pregnant women implement health care provid pregnant women reluct disclos alcohol use health profession comput tailor preserv person anonym effect computertailor intervent recommend attract intervent pregnant women use alcoholtri registr dutch trial regist ntr httpwwwtrialregisternltrialregadminrctviewasptc archiv webcit httpwwwwebcitationorgnptohol

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