Targeted Mechanisms of an Efficacious Intervention: Transtheoretical Model Construct Profiles in Project Choices

Background & Purpose: Project CHOICES Efficacy Trial was a multisite study to test an intervention for the prevention of alcohol-exposed pregnancy (AEP). The intervention was based on Motivational Interviewing and the Transtheoretical Model (TTM). One goal of the CHOICES intervention was to reduce drinking in women at risk of an AEP by targeting the constructs of the TTM that have been found to be associated with successful change. The CHOICES intervention targeted the TTM processes of change, posited to be the mechanisms through which individuals move through the motivational stages of change. In addition, a goal of the CHOICES intervention was to increase the cons and decrease the pros for drinking, decrease temptation and increase confidence to avoid drinking at risk levels (Velasquez, Ingersoll, Sobell, et al., 2010). In the current study, a secondary analysis using Profile Analysis was conducted to compare TTM alcohol construct profiles of women who received the CHOICES intervention compared to profiles of women who received the Information intervention at baseline and at end-of-treatment. Methods: Recruitment sites for Project CHOICES included: a large urban jail and residential alcohol and drug treatment facilities (Texas); a gynecology clinic (Virginia) and two primary care clinics serving low-income women (Virginia and Florida); and media solicitation (Florida). Eligible women were drinking at risk levels (>=5 drinks in one day or more than 7 drinks per week in the past 90 days); fertile; sexually active; not pregnant; and not using effective contraception.  830 women were randomized into the CHOICES intervention (n=416) or Information intervention (n=414). Sixty-nine percent of the women in the CHOICES intervention were at reduced risk for an AEP at nine-months which was twofold greater than in the control group, 2.11 (CI_1.47–3.03). The processes of change, decision balance, and temptation for alcohol were all predictive of reduced risk at nine-months. In the current secondary analysis of the Project CHOICES data, the TTM construct profiles for alcohol consisted of the women’s reported use of the experiential and behavioral processes, pros and cons for drinking, and the situational confidence and temptation associated with changing their drinking.  Results: There were no significant differences found in the TTM construct profiles at baseline. There was a significant parallelism effect (p<.001) and levels effect (p=.031) found for the end-of-treatment TTM construct profiles. CHOICES women had greater reported use of the experiential (p=.004) and behavioral processes (p<.001), greater cons for drinking at risk levels (p<.001), greater confidence (p=.013) to avoid drinking and lower temptation (p=.002) to drink than women who received the Information intervention. Conclusions/Implications: The current secondary analysis demonstrated that Project CHOICES had a positive impact on the targeted TTM constructs that were found to be predictive of reduced risk of an alcohol-exposed pregnancy in Project CHOICES (Floyd, Sobell, Velasquez et al., 2007). Social Workers and other clinicians may improve client’s alcohol outcomes by targeting the experiential and behavioral processes of change, decisional considerations, and confidence and temptation.