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 SPSU OUHSC Barbara Bonner, PhD Larissa Tsvetkova, PhD Alexander Palchick, MD, PhD, Academy of Pediatrics Tatiana Balachova, PhD Vladimir Shapkaitz, MD, PhD, Academy of Pediatrics Karen Beckman, MD Mark Chaffin, PhD Galina Isurina, PhD John Mulvihill, MD Elena Volkova, PhD, Nizhny Novgorod Pedagogical Academy Max Gusev Mark Wolraich, MD Alla Ioffe David Bard, MS 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 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 100 88 92 90 80 70 55 60 50 40 % women 20 30 reported, Russia 10 20 % women 10 reported, USA 0 Pregnant Trying to get Might become pregnant* pregnant 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 70 60.3 60 50.5 % women 50 reported, 40 Russia % women 30 reported, 20 12.4 USA 2.7 10 1.9 0 Pregnant Trying to get Might become pregnant* pregnant 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 90 Always ask non-pregnant about drinking 80 Always ask pregnant about drinking(OBG)/Always 70 ask mothers of infants (Peds) Reported hearing about FAS 60 Occasional alcohol consumption is safe in one of 50 trimesters FAS baby is born with certain birth defects 40 FAS baby is born drunk 30 FAS baby is born addicted to alcohol 20 Acknowledged the lifetime persistence of FAS 10 Agreed that lowered IQ/mental retard. are 0 associated with drinking during pregnancy OBGs Pediatricians 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 Lectures, case examples, discussions, and practice to address knowledge, attitudes, and skills

Phase II: Training for Physicians Study Design 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: Development of Materials Fetal Alcohol Syndrome for Women Fasstar Information Series Brochure 0201B1 FAS and the Brain (Photo courtesy of Sterling Clarren, MD) Brain of normal baby Brain of baby with FAS � Evaluate informational How Prenatal Alcohol Exposure Affects Development of the Brain By Teresa Kellerman Fasstar Enterprises materials for public that Fetal Alcohol Syndrome: Support, Training, Advocacy, & Resources www.fasstar.com 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.

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