Herzig Karen, Danley Dale, Jackson Rebecca, Petersen Ruth, Chamberlain Linda, Gerbert Barbara
Division of Behavioral Sciences, University of California San Francisco, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94117, USA.
Patient Educ Couns. 2006 May;61(2):228-35. doi: 10.1016/j.pec.2005.04.001. Epub 2005 Oct 26.
Our qualitative study explored prenatal care providers' methods for identifying and counseling pregnant women to reduce or stop smoking, alcohol use, illicit drug use, and the risk of domestic violence.
We conducted six focus groups (five with OB/Gyn physicians, one with nurse practitioners and certified nurse midwives), total N=49, using open-ended questions. Investigators analyzed transcripts to identify and describe themes.
Three major themes emerged: (1) specific risk-prevention tactics or strategies exist that are useful during pregnancy; (2) some providers address patients' isolation or depression; and (3) providers can adopt a policy of "just chipping away" at risks. Specific tactics included normalizing risk prevention, using specific assessment techniques and counseling strategies, employing a patient-centered style of smoking reduction, and involving the family.
Providers generally agreed that addressing behavioral risks in pregnant patients is challenging. Patient-centered techniques and awareness of patients' social contexts help patients disclose and discuss risks.
Brief but routine assessment and risk reduction messages require little time of the provider, but can make a big difference to the patient, who may make changes later.
我们的定性研究探讨了产前护理提供者识别并为孕妇提供咨询以减少或戒烟、戒酒、停止使用非法药物以及降低家庭暴力风险的方法。
我们开展了6个焦点小组（5个由妇产科医生组成，1个由执业护士和认证助产士组成），共49人，采用开放式问题。研究人员分析了文字记录以识别和描述主题。
出现了三个主要主题：（1）存在在孕期有用的特定风险预防策略；（2）一些提供者关注患者的孤立或抑郁问题；（3）提供者可以采取“逐步消除”风险的政策。具体策略包括使风险预防常态化、使用特定评估技术和咨询策略、采用以患者为中心的减少吸烟方式以及让家庭参与进来。
提供者普遍认为解决孕妇的行为风险具有挑战性。以患者为中心的技术以及对患者社会背景的了解有助于患者披露和讨论风险。
简短但常规的评估和风险降低信息对提供者来说所需时间很少，但对患者可能产生重大影响，患者随后可能会做出改变。
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