ABSTRACT
OBJECTIVE: To determine the effectiveness of a single session of prenatal motivational interviewing (MI) to enhance breastfeeding outcomes. DESIGN: A randomized controlled trial with two groups (MI and psychoeducation) with repeated measures: preintervention, postintervention, and at 1 month postpartum. SETTING: The intervention was conducted at a university-associated clinic, community locations, and participants' homes. Postpartum follow-up was conducted by telephone. PARTICIPANTS: A total of 81 women with low-risk pregnancies enrolled at 28 to 39 weeks gestation who lived in Appalachia. METHODS: Participants were randomly assigned to MI or psychoeducation on infant development. Pre- and postintervention outcome measures included intention to breastfeed, confidence in and importance of breastfeeding plan, and breastfeeding attitudes. At 1 month postpartum, participants completed a telephone interview to assess actual breastfeeding initiation, exclusivity, and plans to continue breastfeeding. RESULTS: At 1 month postpartum, women in the MI group were more likely to report any current breastfeeding than women in the psychoeducation group, regardless of parity, χ2(1, N = 79) = 4.30, p = .040, Φ = .233. At the postintervention time point, the MI intervention had a significant effect on improving attitudes about breastfeeding among primiparous women only (p < .05). CONCLUSION: One session of MI was effective to promote breastfeeding at 1 month postpartum and to enhance positive attitudes toward breastfeeding among primiparous women in Appalachia.
Subject(s)
Breast Feeding/methods , Child Development/physiology , Counseling/methods , Health Promotion/organization & administration , Mothers/education , Motivational Interviewing/methods , Adult , Ambulatory Care Facilities , Appalachian Region/ethnology , Breast Feeding/psychology , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Infant, Premature , Maternal Behavior , Mother-Child Relations , Mothers/psychology , Pregnancy , Time FactorsABSTRACT
Burn injuries are significant medical traumas often resulting in substantial psychosocial distress. Early identification of psychosocial concerns is crucial to developing individualized treatments to improve psychosocial functioning. Few studies have examined the prevalence of a broad range of psychosocial concerns in an adult outpatient burn setting. In this study, they developed and implemented a screening instrument to identify patients experiencing acute psychosocial distress/risk and patients with mental health difficulties necessitating a psychology consult. The instrument assessed depression, anxiety, substance abuse, posttraumatic stress, perceived safety at home, and suicidal ideation. Adult patients (N = 178) completed the screener during an initial outpatient clinic visit. Responses on the screener were used to identify patients as "high risk" (ie, endorsing suicidal ideation and/or feeling unsafe at home), "moderate risk" (ie, endorsing no-acute mental health symptoms), or "low risk" (ie, few to no symptoms endorsed). Patients in the "high risk" category were immediately evaluated by the attending physician, who then determined whether emergency treatment was needed. Patients in the "moderate risk" category were referred to the on-site psychology team for in-person or phone consultation within 3 days of screener completion. Of the 178 individuals screened, a majority endorsed low to no psychosocial distress (N = 124; 69.7%). About one-third (N = 52) indicated moderate levels of psychosocial distress, and two patients (1.1%) endorsed acute psychosocial distress. This novel screening tool was effectively implemented in an outpatient burn clinic and demonstrates considerable promise for identifying psychosocially vulnerable patients in an adult burn survivor population.
