Efeito do monitoramento por telefone de Intervenções Breves para uso de álcool e tabaco entre gestantes: ensaio clínico randomizado

Abstract

Objective: to test whether telephone monitoring adds to short-term alcohol and tobacco intervention among pregnant women. Method: This is a randomized, open, two-arm clinical trial. Data were collected at the Basic Health Units of São Carlos / SP and at the Reference Center for Women's Health in Ibaté / SP, from December 2017 to April 2018. All the pregnant women who sought these services were recruited, aged 18 or over and gestational age 12 to 30 weeks. The study was conducted in three phases: screening stage of alcohol and tobacco use; randomized clinical trial and post-test. For randomization, the participants were allocated to two groups: "Control Group" (received a brief intervention without monitoring); "Experimental Group" (received an intervention and two monitoring phone calls, for two weeks). In the post-test, the same variables measured in the pre-test were re-evaluated. The intervention was performed at the participants' home. For alcohol, an already validated protocol was used for brief interventions among pregnant women and, for tobacco, a strategy known as "5Rs strategy". The instruments used were: sociodemographic and obstetric questionnaire; Alcohol Use Disorders Identification Test (AUDIT-C); Tolerance, Annoyed, Cut Down, Eye opener (T-ACE); Involvement screening test with alcohol, cigarette and other substances (ASSIST); and Fagerström Test. Statistical Package for Social Science (SPSS), version 22.0, Epiinfo version 7.2 (for descriptive statistics), Kolmogorov-Smirnov test (to verify data distribution) and Wilcoxon's test (for comparison) were used to analyze the data. of averages before and after interventions). Results: 112 pregnant women, with a gestational age of 18 weeks, participated in the study. The mean age was 27.4 years. In the screening performed to verify alcohol consumption during gestation, 31 (27.6%) were positively tracked and included in the study. In relation to tobacco use, 13 (11.6%) were identified as smokers. The hypothesis of the study was confirmed only for alcohol use, because although there was a reduction in the consumption of the two groups observed, there was a significant difference (p-value <0.05) in the mean of the AUDIT-C and T-ACE in relation to pre and post-test (in which all the pregnant women in the experimental group remained abstinent during the period of the experiment). In relation to tobacco use, monitoring was not able to promote significant changes (p-value> 0.05) in the smoking behavior of pregnant women. However, there was a reduction in the mean of the ASSIST scores in both groups and in the Fagerström Test score only in the experimental group. Conclusion: it was evident that the monitoring of interventions, even by telephone, demonstrated the potential to cease and / or reduce alcohol consumption during pregnancy. For tobacco, there is a need for other intervention actions, in addition to monitoring. Health professionals, besides being able to intervene on the use of alcohol and tobacco among pregnant women, need to be able to monitor their intervention and to know possible ways to do so.