Page 23 - Zero for nine: Reducing alcohol use during pregnancy via health counselling and Internet-based computer-tailored feedback

to an individual or group to prevent or treat health issues, including 1 substance abuse and addiction (Joffe & Radius, 1991). In international
studies (Chang, et al., 1999; Handmaker, Miller, & Manicke, 1999;
O’Connor & Whaley, 2007; Reynolds, et al., 1995), HC has been effective in
reducing prenatal alcohol consumption, as has been shown by a recent review on psychological and educational interventions to reduce alcohol consumption by pregnant women (Stade, et al., 2009). Although HC has successfully been used in a prenatal smoking cessation intervention provided by Dutch midwives (De Vries, et al., 2006a), currently, there is no effective HC intervention available for Dutch midwives who want to help their clients to change their alcohol use. A drawback of HC is the large responsibility of health professionals to adequately implement the intervention. Previous research on smoking cessation in pregnancy (Lumley, et al., 2009) has shown that health professionals’ lack of time (Hajek, et al., 2001), pessimism about the effectiveness of the intervention (McLellan, et al., 2000), perceived lack of skills and training (De Vries, et al., 2006a) and administrative barriers (Strand, et al., 2003) were disadvantageous for the efficacy of the intervention.
This drawback of health professionals’ responsibility for an adequate implementation can be overcome by an alternative and promising strategy, called computer tailoring (CT; De Vries & Brug, 1999). As with HC, the content of this advice is based on the answers of respondents to questions relating to a certain behaviour. In contrast to HC, the advice is not delivered face-to-face by a health professional, but generated by a computer program. As the feedback is adapted to the specific characteristics of a particular individual, it yields the potential to provide messages highly tailored to the individuals’ situation (Hawkins, et al., 2008). CT messages have been shown to attract and keep an individual’s attention (De Vries & Brug, 1999; Kreuter, 1999) more than generic advice, resulting in a more thorough processing of information (Dijkstra, 2005). CT has proven to be effective in changing different health related behaviours (De Vries, et al., 2008; Krebs, Prochaska, & Rossi, 2010), like smoking (E.S. Smit, de Vries, & Hoving, 2012), vegetable and fruit intake (Oenema, Tan, & Brug, 2005) and alcohol use (Boon, et al., 2011; Schulz, et al., 2013). To our knowledge, only one CT intervention for alcohol use
General Introduction
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