QING LI
Non-Degree Seeking Student, Colorado School of Public Health, Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University

Perinatal teen dating violence (PTDV) is a serious public health issue. Among pregnant teens, the lack of a vision of commitment to make future-oriented decisions (e.g., precocious coresidential unions, infidelity, jealousy, and second pregnancy) is a core generator of relationship instability and often leads to PTDV. A promising venue to prevent PTDV may be the home visitation methods of the Nurse Family Partnership (NFP), an evidence-based preventive intervention in a service delivery model. Relationship education programs (e.g. the Prevention and Relationship Enhancement Program, PREP) have already shown promise in reducing dating violence and intimate partner violence (IPV). However, commitment and relationship education have been underemphasized in NFP—only one trial in Oregon taught them. According to Hirschi’s control theory (1969), we hypothesize that weak social bonds and lack of commitment are modifiable precursors of PTDV.

In a secondary data analysis of this randomized controlled trial (RCT), first-time and low-income mothers were recruited and randomly assigned to (1) NFP group or (2) NFP and PREP (called NFP+) group in Multnomah County, Oregon from 2007 to 2011. After 238 women completed the baseline survey, retention was 81% after 1- and 2-year follow-up surveys. Among 67 mothers aged 15-17, we analyzed the effectiveness of NFP+ program to increase commitment and prevent PTDV.

The primary prevention component was teaching the adapted Within My Reach (WMR) Curriculum based on the PREP, when commitment was taught along with decision-making (e.g. decide, do not slide, select a mate). We operationalized commitment as being married or engaged. The sum of any type of physical and sexual victimization and/or perpetration in the past 12 months in the Revised Conflict Tactics Scale was coded as a continuous outcome and 0 across 3 time points indicated free of violence.

Among 67 teen moms, the NFP+ and NFP groups had no difference in age and educational status (both p=0.82). There were more Hispanic mothers (59%) in NFP+ group and more White, non-Hispanic mothers (42%) in NFP group. There were 22 teens who reported commitment (being engaged or married) at least once in 3 time points. In the NFP+ group, 6 of 11 teens started without violence and 4 (66%) stayed free of violence 2 years later. In the NFP group, only 2/5 (40%) stayed free of violence. More teens in NFP+ stayed in committed and stable relationship with the child’s father (3 engaged and 4 married vs 5 engaged and 2 living together and dating exclusively).

Preliminary findings show that this enhanced NFP program improved commitment and relationship stability and prevented PTDV. We plan an R34 pilot study and then an RO1 powered cluster RCT to perform covariate constrained randomization and linear mixed models and evaluate commitment as modifiable precursors to prevent PTDV.

ANDREA E. DADDATO, MS, MS
Professional Research Assistant, PhD Candidate, Division of Geriatric Medicine, University of Colorado School of Medicine

Among older adults without cognitive impairment, a novel advance care planning group visit (ACP-GV) intervention increased ACP documentation and readiness to engage in ACP. For individuals with mild cognitive impairment (MCI), planning for their future medical wishes and values of importance before further cognitive decline is important. A key question is whether a pragmatic intervention can be adapted to support people with MCI and their family care partners.

Individuals with MCI and study partners recruited as dyads from an academic healthcare system in Aurora, Colorado.

To design for pragmatic implementation, we used a human-centered design process, rapid-cycle prototyping, and qualitative methods guided by the frameworks of the NIH Stage Model for Behavioral Intervention Development to adapt an ACP-GV intervention to individuals with MCI and their study partners (dyads).1,2 We convened a longitudinal cohort of six dyads in three focus groups to suggest adaptations. We also conducted a single arm study of four ACP-GV prototypes (n=13 dyads total) that were iteratively refined with adaptations from the longitudinal cohort and participant feedback. We used interviews after each prototype to gather feedback.

Six dyads met three times from February-October 2019 to discuss intervention adaptations, such as what ACP decision tools should be used and what outcomes would be meaningful for an ACP-GV intervention adapted for individuals with MCI. Stakeholder feedback informed four n-of-1 adapted ACP-GV interventions with an average of 3.25 dyads per group visit. Following the completion of each ACP-GV, 20 participants were interviewed for feedback of whether the intervention met their expectations and goals related to ACP, effectiveness of the tools/resources, format of the intervention, and recommendations for future ACP-GVs. Feedback from the interviews were reported back to the longitudinal focus group for further input. Overall, interviewees found the group visit setting helpful to hear others perspectives and to initiate tough conversations about end-of-life planning. Most felt the size of the ACP-GVs were appropriate, the videos and resources were helpful, and would recommend the intervention to others. The longitudinal focus group reported ACP as a priority for individuals with MCI and described the need for ACP in a group setting. An additional theme was to include candid conversation about the diagnosis of MCI and how it relates to the need for ACP.

Use of a pragmatic research approach with rapid prototyping and stakeholder engagement allowed testing of different resources and tools aimed at helping individuals with MCI and their partners discuss ACP. Future work is needed to understand the feasibility of implementing an ACP-GV intervention for individuals with MCI into clinical settings.