Richards Jennifer, Mousseau Alicia
Am Indian Alsk Native Ment Health Res. 2012;19(1):154-85. doi: 10.5820/aian.1901.2012.154.
Sacred Beginnings is a community-based participatory research project that examines the effectiveness of a culturally appropriate preconception health educational intervention developed by tribal community members and elders. The primary goal is to increase knowledge of preconception health and its benefits among adolescent females and tribal communities. Preconception health is an area of considerable concern among American Indians (AIs) in the Northern Plains region, as there are high rates of birth, infant mortality, unintended pregnancy, teen pregnancy, and sexually transmitted diseases in this area. We examined the effectiveness of implementing this intervention during a residential summer program for AI high school students.
The educational intervention consisted of 15 preconception health education sessions and was piloted during a summer high school residential academic program. The intervention (N = 39) and non-intervention (N = 38) groups were comprised of incoming AI female freshmen representing comparable demographics. A pre- and post-intervention survey was administered to both groups.
Results indicated a significant difference in Time 2 (T2; post-intervention) scores, with the intervention group scoring higher than the non-intervention group in overall preconception health knowledge and obesity knowledge. In terms of intra-group score analysis between Time 1 (T1; pre-intervention) and T2, there were significant changes within the intervention group in knowledge of obesity and diabetes. Knowledge changes in smoking were approaching significance. Within the non-intervention group, there was a significant change from T1 to T2 in scores for diabetes knowledge only.
The key finding was that the intervention group had higher overall preconception health knowledge at T2 compared to the non-intervention group. Intervention participants demonstrated an understanding of how preconception behaviors may affect birth outcomes and maternal health. Another key finding was that, among participants in the intervention group, the change in knowledge regarding smoking beliefs between T1 and T2 were approaching significance. Because smoking during pregnancy is a risk factor for poor birth outcomes, this finding emphasizes that future curriculum modification should address the effects of smoking, and the benefits of smoking cessation, prior to or during pregnancy. Study limitations such as small sample size, high baseline health knowledge, the need to add traditional knowledge variables, and shortened implementation timeframe reveal key areas for improvement. Possible future intervention modifications include expanding on areas that reached or approached significance, implementing the intervention over a longer period of time, identifying ways to translate traditional knowledge into quantifiable survey measures, and implementing the intervention with high-risk, reservation-based populations of AI youth.
“神圣开端”是一个基于社区的参与性研究项目，旨在检验由部落社区成员和长者开发的具有文化适宜性的孕前健康教育干预措施的有效性。主要目标是提高青少年女性和部落社区对孕前健康及其益处的认识。孕前健康是北平原地区美国印第安人（AI）相当关注的一个领域，因为该地区的出生率、婴儿死亡率、意外怀孕、青少年怀孕和性传播疾病的发生率都很高。我们研究了在AI高中生的暑期住校项目中实施该干预措施的有效性。
教育干预包括15次孕前健康教育课程，并在高中暑期住校学术项目中进行了试点。干预组（N = 39）和非干预组（N = 38）由具有相似人口统计学特征的即将入学的AI女新生组成。两组均进行了干预前和干预后的调查。
结果表明，在时间2（T2；干预后）得分上存在显著差异，干预组在总体孕前健康知识和肥胖知识方面的得分高于非干预组。就时间1（T1；干预前）和T2之间的组内得分分析而言，干预组在肥胖和糖尿病知识方面有显著变化。吸烟知识的变化接近显著水平。在非干预组中，仅糖尿病知识得分从T1到T2有显著变化。
关键发现是，与非干预组相比，干预组在T2时的总体孕前健康知识水平更高。干预参与者表现出对孕前行为如何影响出生结局和孕产妇健康的理解。另一个关键发现是，在干预组参与者中，T1和T2之间关于吸烟观念的知识变化接近显著水平。由于孕期吸烟是不良出生结局的一个风险因素，这一发现强调未来的课程修改应在怀孕前或怀孕期间解决吸烟的影响以及戒烟的益处。研究局限性，如样本量小、基线健康知识水平高、需要添加传统知识变量以及实施时间缩短，揭示了需要改进的关键领域。未来可能的干预改进措施包括扩展达到或接近显著水平的领域、在更长时间内实施干预、确定将传统知识转化为可量化调查指标的方法，以及对基于保留地的高风险AI青年人群实施干预。
