Where there’s a will, there’s a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol‐exposed pregnancy preconceptual intervention

Abstract

Background: Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention.Methods: One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/ abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. Results:Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. Conclusion:Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.

Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review

“…Eleven studies focused on the development, implementation, and/or evaluation of interventions to prevent alcohol-exposed pregnancy ( Table 3 ) [ 45 , 63 , 65 , 68 , 69 , 70 , 71 , 74 , 77 , 78 , 79 , 87 ]. Quantitative evaluations of these interventions showed positive outcomes in reducing the risk of alcohol-exposed pregnancy in several studies [ 68 , 69 , 71 ] and no significant change between intervention and control groups in one study [ 78 ].…”

“…A number of common themes emerged from qualitative data collection relating to the development, implementation, or evaluation of preconception health interventions. These included the role of family, community, and/or culture in promoting positive health behaviours [ 63 , 65 , 74 , 77 , 81 , 88 , 92 ]; the importance of culturally appropriate content [ 65 , 68 , 79 , 80 , 81 , 92 ]; the need for factual content on preconception health risks [ 65 , 80 , 88 , 89 ]; the need for effective communication with adolescents [ 74 , 81 , 88 , 92 ]; and the importance of a strength-based or empowerment approach [ 68 , 80 ].…”

“…There is benefit in designing and rigorously evaluating interventions for Indigenous peoples which address multiple preconception health risk factors in a holistic and culturally appropriate manner. The review identified a number of common themes relating to the development, implementation, or evaluation of preconception health interventions, including the role of family, community, and/or culture in promoting positive health behaviours [ 63 , 65 , 74 , 77 , 81 , 88 , 92 ]; the importance of culturally appropriate content [ 65 , 68 , 79 , 80 , 81 , 92 ]; and the importance of a strength-based or empowerment approach [ 68 , 80 ]. While these themes are supported by the broader literature on creating culturally appropriate health interventions for Indigenous peoples [ 103 , 104 , 105 ], preconception health interventions need to also ensure that Indigenous peoples are actively involved in every stage of program development and delivery.…”