Primary Outcomes: Feasibility and Acceptability of POWER
Feasibility. All screened individuals met study eligibility criteria and enrolled (n = 87). The 3-month follow-up completion rate was 79%. The average number of sessions attended was 8.99 out of 10 for POWER participants and 8.02 out of 10 for control participants. Forty POWER participants completed the exit survey. The control group did not complete an exit survey. Participants indicated that the clinic’s location in the community played a large role in their session attendance.
Acceptability. Participants ranked the sessions they liked most and least. The emotion regulation session was ranked highest (77.5%), followed by healthy relationships (47.5%) and communication skills (45%). 67.5% of participants endorsed ‘not applicable’ regarding least liked sessions. The remaining participants reported that they liked the sexual health, prenatal distress, and sexual values sessions the least. Deep breathing (M = 2. 77 times per week), muscle relaxation (M = 3.05 times per week), meditation (M = 3.15 times per week), talking to someone (M=3.74 times per week), and listening to music (M=3.77 times per week) were the adaptive coping skills practiced most outside of the group.
Based on a 4-point likert scale rating, the average rating for facilitation satisfaction was 2.51. Communication was identified as an area for facilitator improvement. Participants reported that the facilitator “could speak and make her words clearer” and “she could speak slower.” Participants’ feedback about their likes centered on themes of facilitator helpfulness (e.g., “she make me understand”; “she always talks to me to help me manage my stress”; “she is very encouraging people and explains the topics well”).
Participants reported positive feelings and also some sadness about program completion. For example, one participant said, “I feel good because it educated me along.” Other participants said, “I feel good and bad because the program empowered me by more knowledge… I feel bad because I won’t be seeing the program again”, and indicated a desire to continue learning (e.g., “I don’t want the program to end,” “I want to learn more”).
Preliminary Efficacy: Mental and Sexual Health Outcomes
The effect sizes for the secondary outcomes are provided in Table 3. These include Cohen’s D’s for time, group, and group by time estimates.
Table 3
Effect sizes of Secondary Outcomes
| PCL | PDQ | TS | PHQ |
| Partial η2 | Partial η2 | Partial η2 | Partial η2 |
Timea | .55* | .75** | .55* | 1.44*** |
Group | .00 | .44 | .35 | .58 |
Time * Group | .33 | .06 | .59* | .80* |
Note: a indicates that data was collapsed across pre- and post-intervention. *p <.05, **p < .01, ***p < .001 |
Depressive Symptomology. Results of mixed ANOVA for depression symptoms indicated a significant effect by time [F(1,41)=21.179, p=.000, Cohen’s d=1.44] and time by group [F(1,41)=6.621, p=.014, Cohen’s d=.80]. Symptoms of depression decreased from baseline (M=5.09, SD=4.14) to 3-month follow-up (M=2.63, SD=2.70). There was no significant effect by group [F(1,41)=3.487, p=.069, Cohen’s d=.54]. There was no significant difference in depression for the control condition at 3-month follow-up [F(1,41)=2.60, p<.11, Cohen’s d=.51].
Prenatal Distress. Results of mixed ANOVA for prenatal distress showed a significant effect of time [F(1,66)=9.219, p=.003, Cohen’s d=.75]. Distress decreased from baseline (M=16.84, SD=11.17) to Time 2 (M=12.24, SD=9.49).There were no significant difference by group [F(1,66)=3.284, p=.75, Cohen’s d=.44], nor was there a significant time by group difference [F(1,66)=0.043, p=.836, Cohen’s d=.06].
PTSD Symptoms. There was a significant effect of time [F (1,66=4.952, p=.29, Cohen’s d=.55]. PTSD symptoms decreased from baseline (M=11.97, SD=6.80) to 3-month follow-up (M=9.79, SD=5.71). There were no significant differences by group [F(1,66=0.004, p=.952, Cohen’s d=.00] nor was there a significant time by group interaction [F(1,66)=1.862, p=.177, Cohen’s d=.33].
Transactional Sex. For transactional sex, results of mixed ANOVA showed a significant effect of time [F(1,66)= 5.061, p=.028, Cohen’s d=.55]. Transactional sex decreased from baseline (M=1.37, SD=1.71) to 3-month follow-up (M=.94, SD=1.21). There were no significant differences by group [F(1,66=5.061, p=.028, Cohen’s d=.55] however this effect is qualified by a time by group interaction [F(1,66=5.698, p=.020, Cohen’s d=.59]. Transactional sex decreased from baseline (M=1.84, SD=2.08) to 3-month follow-up (M=.91, SD=1.2) for the control group [F(1,66=10.15, p < .001, Cohen’s d=.78]. Transactional sex was stable from baseline (M=.94, SD=1.19) to 3-month follow-up (M=.97, SD=1.23) for the POWER group [F(1,66=0.01, p=.921, Cohen’s d=.00].