How health care setting affects prenatal providers' risk reduction practices: a qualitative comparison of settings.

Background: We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks.

Methods: We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors.

Comparing prenatal providers' approaches to four different risks: alcohol, tobacco, drugs, and domestic violence.

Objective: We explored prenatal care providers' methods for addressing four behavioral risks in their pregnant patients: alcohol use, smoking, drug use, and domestic violence.

Design: We used qualitative, purposively sampled, focus group data.

Setting: Groups met in professional focus group settings.

Reframing "prevention with positives": incorporating counseling techniques that improve the health of HIV-positive patients.

Federal HIV prevention strategy seeks to increase efforts by health care providers to identify and reduce their HIV-positive patients' transmission-related behaviors. Implementation of these recommendations will be hindered if providers perceive these efforts have the potential to harm their relationships with patients. Because transmission-related behaviors (unsafe sex and sharing needles) and the related issues of drug and alcohol use also jeopardize the health of HIV-positive patients, providers can use patient-centered counseling when addressing those behaviors.