prevention - university of british columbia · 2019. 4. 1. · roozen s, peters gy, kok g, townend...

Prevention

Sylvia Roozen

Presenter Disclosure

Sylvia Roozen

I have no current or past relationship with commercial entities.

Negative effects

Positive effects

Why should we care?

Roozen S, Peters GY, Kok G, Townend D, Nijhuis JG, & Curfs LMG. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis. Alcoholism, Clinical and Experimental Research. 2016: 40(1), p 18-32. DOI 10.1111/acer.12939.Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health, 5(3), e290-e299.

ARND5.19 per 1,000

ARBD3.52 per 1,000

pFAS11.22 per 1,000

FASD22.22 per 1,000

FAS2.89 per 1,000

FAS1.46 per 1,000Popova et al., 2017

Down Syndrome1 per 1,000

Lessons of history we’ve failed to learn

FASD Prevention

“The act of stopping something from happening”

Primary Secondary TertiaryEarly detection,

minimizing outcomes

Retain QoL, disease control

Occurrence

What has been done so far?

Ehrhart, F.*, Roozen, S.*, Verbeek, J., Koek G., Kok, G., Van Kranen, H., Evelo, C. T., Curfs, L.M.G (2018). Review and gap analysis: molecular pathways leading to Fetal Alcohol Spectrum Disorders. Molecular Psychiatry, 1

Management and care

Problem identification Problem Solving

Health Promoting

Goal

Health Promoting

Program

Roozen, S., Black, D., Peters, G.Y., Kok, G., Townend, D., Nijhuis, J.G., Koek, G.H. and Curfs, L.M.G. (2016). Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention. Current Developmental Disorders Reports, pp.1-6.

Who to Influence?

Society: Governmentalagencies, PoliciesCommunity: Community leadersOrganization: Hospital, Healthcare providersInterpersonal: Partner, Family, Friends

Individual: Pregnant women, Women in childbearing age, Womenwith alcohol abuse, Etc.

Example ApproachesLarge-scale campaigns, alcohol policy, network linkages, researchCommunity-based interventions, mobilizing advocacyHolistic services for e.g., high risk pregnant womenSupport Services for e.g., family

Screening, brief ìnterventions(motivational interviewing)

Desired behavior(s)

What to Change?Undesired behavior(s)

?

?

?

?

Beliefs “My family said that drinking alcohol would help me

during pregnancy”

“If I have already eaten well and I

drink a little glass of red wine, I do not

feel that I put my baby at risk”

“Some family members or friends also drank alcohol throughout

pregnancy and had very normal, even beautiful

kids”

“If I do not drink alcohol in

pregnancy I feel more stressed”

Roozen, S., Peters, G. Y., Kok, G., & Curfs, L (2018). Identifying psychosocial determinants related to alcohol consumption during pregnancy: a systematic literature review. Preprint.

DeterminantsInjunctive

norm

Risk perception

Descriptive norm

Attitude /Self Efficacy

Roozen, S., Peters, G. Y., Kok, G., & Curfs, L (2018). Identifying psychosocial determinants related to alcohol consumption during pregnancy: a systematic literature review. Preprint.

France, K. E., Donovan, R. J., Bower, C., Elliott, E. J., Payne, J. M., D’Antoine, H., & Bartu, A. E. (2014). Messages that increase women’s intentions to abstain from alcohol during pregnancy: results from quantitative testing of advertising concepts. BMC Public Health, 14(1), 30.

Attitude Response efficacy Instrumentalattitude

Perceived norm Descriptive norm Injunctive norm

Self-efficacy Capacity Autonomy

Habit Perceived social support Skills

Knowledge Craving Motivation to comply

Applying Methods

Methods - Parameters

Kok, G., Gottlieb, N. H., Peters, G. J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A., ... & Bartholomew, L. K. (2016). A taxonomy of behaviour change methods: an Intervention Mapping approach. Health psychology review, 10(3), 297-312.

Effectiveness?

Health Problem

Intervention/ Program

Intervention/ Program

Intervention/ Program

?

?

The Need for a Framework

Step 1Problem analysis

Needs assessment

Step 2Program Objectives

Determinant analysis

Step 3Program Design

Methods & Applications

Step 4Program

ProductionIntervention

Step 5Implementation

Plan

Step 6Evaluation Plan

Now what? FASD is an important health problem in need of prevention

FASD warrants simultaneous prevention on multiple levels

and requires a multidisciplinary approach

For FASD prevention there is room for improvement

Decisions about prioritizing short-term and log-term actions

are important

“Each one of us can make a difference. Together we make change”

sylvia.roozen@maastrichtuniversity.nl

2040?

Given the complexity of FASD prevention, what two areas would you consider to be prevention

research priorities over the next 20 years?Why?