developing educational materials for prevention of fas
TRANSCRIPT
CENTER ON CHILD ABUSE AND NEGLECTBarbara 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 of 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
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
0 10 20 30 40 50 60 70 80 90
100
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
0
10
20
30
40
50
60
70
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
0
10
20
30
40
50
60
70
80
90
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 of 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
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.
Fetal Alcohol Syndrome Fasstar Information Series Brochure 0201B1
FAS and the
Brain of normal baby Brain of baby with FAS
How Prenatal Alcohol Exposure Affects
Development of the Brain By Teresa Kellerman
Fasstar Enterprises Fetal Alcohol Syndrome: Support, Training, Advocacy, & Resources
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
(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
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
Important to have bilingual staff at both
Universities
Developing Educational Materials for Prevention of FAS/FASD in Russia
University of Oklahoma Health Sciences Center in Collaboration with St. Petersburg State University
Project Team
Phase I: Women’s reported binge drinking
Phase I: Survey of Physicians
Phase I: Conclusions
Phase I: Conclusions
Phase II: Objectives
Phase II: Curriculum for Pediatricians (3 hours)
Phase II: Training for Physicians Study Design
Phase II: Development of Materials for Women
Phase II: Focus Groups
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 of 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
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
0 10 20 30 40 50 60 70 80 90
100
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
0
10
20
30
40
50
60
70
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
0
10
20
30
40
50
60
70
80
90
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 of 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
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.
Fetal Alcohol Syndrome Fasstar Information Series Brochure 0201B1
FAS and the
Brain of normal baby Brain of baby with FAS
How Prenatal Alcohol Exposure Affects
Development of the Brain By Teresa Kellerman
Fasstar Enterprises Fetal Alcohol Syndrome: Support, Training, Advocacy, & Resources
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
(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
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
Important to have bilingual staff at both
Universities
Developing Educational Materials for Prevention of FAS/FASD in Russia
University of Oklahoma Health Sciences Center in Collaboration with St. Petersburg State University
Project Team
Phase I: Women’s reported binge drinking
Phase I: Survey of Physicians
Phase I: Conclusions
Phase I: Conclusions
Phase II: Objectives
Phase II: Curriculum for Pediatricians (3 hours)
Phase II: Training for Physicians Study Design
Phase II: Development of Materials for Women
Phase II: Focus Groups