Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Care | Research article

The conversation matters: a qualitative study exploring the implementation of alcohol screening and brief interventions in antenatal care in Scotland

Authors: Lisa Schölin, Niamh Fitzgerald

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

Login to get access

Abstract

Background

Alcohol screening and brief intervention (SBI) in antenatal care is internationally recommended to prevent harm caused by alcohol exposure during pregnancy. There is, however, limited understanding of how SBI is implemented within antenatal care; particularly the approach taken by midwives. This study aimed to explore the implementation of a national antenatal SBI programme in Scotland.

Methods

Qualitative interviews were conducted with antenatal SBI implementation leaders (N = 8) in eight Scottish health boards. Interviews were analysed thematically and using the ‘practical, robust implementation and sustainability model’ (PRISM) to understand differences in implementation across health boards and perceived setting-specific barriers and challenges.

Results

In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women’s alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women’s responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important.

Conclusions

This is the first study to explore implementation leaders’ experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. In contrast with current antenatal alcohol screening recommendations, a conversational approach was advocated to enhance the accuracy and honesty of reporting. This may enable provision of support to more women to prevent Fetal Alcohol Spectrum Disorders (FASD) and will therefore be of international interest.
Literature
1.
Riley EP, Infante MA, Warren KR. Fetal alcohol spectrum disorders: an overview. Neuropsychol Rev. 2011;21(2):73–80.CrossRef
2.
Clarke ME, Gibbard WB. Overview of fetal alcohol spectrum disorders for mental health professionals. Can Child Adolesc Psychiatr Rev. 2003;12(3):57–63.PubMedPubMedCentral
3.
O'Leary CM. Fetal alcohol syndrome: a literature review. National Alcohol Strategy 2001 to 2003–04. Canberra: Commonwealth of Australia; 2002.
4.
5.
Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(3):e290–9.CrossRef
6.
7.
8.
Heather N. Developing, evaluating and implementing alcohol brief interventions in Europe. Drug Alcohol Rev. 2011;30(2):138–47.CrossRef
9.
Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2018;2:CD004148.PubMed
10.
O'Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol. 2014;49(1):66–78.CrossRef
11.
McCambridge J, Saitz R. Rethinking brief interventions for alcohol in general practice. BMJ. 2017;356:j116.CrossRef
12.
Stade BC, Bailey C, Dzendoletas D, Sgro M, Dowswell T, Bennett D. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. Cochrane Database Syst Rev. 2009;2:CD004228.
13.
Gilinsky A, Swanson V, Power K. Interventions delivered during antenatal care to reduce alcohol consumption during pregnancy: a systematic review. Addict Res Theory. 2011;19(3):235–50.CrossRef
14.
15.
16.
Scottish Executive. Alcohol Fertility and Pregnancy - New Communications Guidance (Vol. 30103302). Edinburgh: Scottish Executive; 2007.
17.
18.
Nilsen P, Wåhlin S, Heather N. Implementing brief interventions in health care: lessons learned from the Swedish risk drinking project. Int J Environ Res Public Health. 2011;8(9):3609–27.CrossRef
19.
20.
Stead M, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, et al. Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health. 2017;17(1):357.CrossRef
21.
Novick G. Is there a Bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391–8.CrossRef
22.
Clark J. How to peer review a qualitative manuscript. In: Goodle F, Jefferson T, editors. Peer review in Health sciences (2nd edition). London: BMJ Books; 2003.
23.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRef
24.
Fitzgerald N, Platt L, Heywood S, McCambridge J. Large-scale implementation of alcohol brief interventions in new settings in Scotland: a qualitative interview study of a national programme. BMC Public Health. 2015;15:289.CrossRef
25.
Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–6.CrossRef
26.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
27.
Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008;34(4):228–43.CrossRef
28.
Chan AWK, Pristach EA, Welte JW, Russell M. Use of the TWEAK test in screening for alcoholism/ heavy drinking in three populations. Alcohol Clin Exp Res. 1993;17(6):1188–92.CrossRef
29.
30.
Doi L, Cheyne H, Jepson R. Alcohol brief interventions in Scottish antenatal care: a qualitative study of midwives' attitudes and practices. BMC Pregnancy Childbirth. 2014;14(1):170.CrossRef
31.
Jones SC, Telenta J, Shorten A, Johnson K. Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive? Midwifery. 2011;27(4):489–96.CrossRef
32.
Muggli E, Cook B, O'Leary C, Forster D, Halliday J. Increasing accurate self-report in surveys of pregnancy alcohol use. Midwifery. 2015;31(3):e23–8.CrossRef
33.
Phillips D, Thomas K, Cox H, Ricciardelli LA, Ogle J, Love V, Steele A. Factors that influence Women's disclosures of substance use during pregnancy: a qualitative study of ten midwives and ten pregnant women. J Drug Issues. 2007;37(2):357–75.CrossRef
34.
NHS Health Scotland. Delivering an ABI : process, screening tools and guidance notes: alcohol brief interventions antenatal professional pack. Edinburgh: NHS Health Scotland; 2015.
35.
Kennedy C, Finkelstein N, Hutchins E, Mahoney J. Improving screening for alcohol use during pregnancy: the Massachusetts ASAP program. Matern Child Health J. 2004;8(3):137–47.CrossRef
36.
O'Brien PL. Performance measurement: a proposal to increase use of SBIRT and decrease alcohol consumption during pregnancy. Matern Child Health J. 2014;18(1):1–9.CrossRef
37.
38.
Wangberg SC. Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy. Sex Reprod Healthc. 2015;6(3):186–90.CrossRef
39.
Herzig K, Danley D, Jackson R, Petersen R, Chamberlain L, Gerbert B. Seizing the 9-month moment: addressing behavioral risks in prenatal patients. Patient Educ Couns. 2006;61(2):228–35.CrossRef
40.
Skagerström J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Women's Health. 2011;20(6):901–13.CrossRef
41.
McBride N, Carruthers S, Hutchinson D. Reducing alcohol use during pregnancy: listening to women who drink as an intervention starting point. Glob Health Promot. 2012;19(2):6–18.CrossRef
42.
Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, et al. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med. 2015;30(8):1125–32.CrossRef
43.
McCambridge J, Rollnick S. Should brief interventions in primary care address alcohol problems more strongly? Addiction. 2014;109(7):1054–8.CrossRef
44.
McQuire C, Paranjothy S, Hurt L, Mann M, Farewell D, Kemp A. Objective measures of prenatal alcohol exposure: a systematic review. Pediatrics. 2016;138(3):e20160517.CrossRef
45.
Sher J, Frank JW, Doi L, de Caestecker L. Failures in reproductive health policy: overcoming the consequences and causes of inaction. J Public Health. 2019;41(2):e209–e215.CrossRef
46.
Usmani ZC, Craig P, Shipton D, Tappin D. Comparison of CO breath testing and women's self-reporting of smoking behaviour for identifying smoking during pregnancy. Subst Abuse Treat Prev Policy. 2008;3(1):4–4.CrossRef
47.
Howlett H, Abernethy S, Brown NW, Rankin J, Gray WK. How strong is the evidence for using blood biomarkers alone to screen for alcohol consumption during pregnancy? A systematic review. Eur J Obstetrics Gynecol Reprod Biol. 2017;213:45–52.CrossRef
48.
Gaume J, McCambridge J, Bertholet N, Daeppen J-B. Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review. Front Psychiatry. 2014;5:108.CrossRef
49.
Begun JW, Zimmermann B, Doley K. Health care organizations as complex adaptive systems. In: Mick SM, Wyttenbach M, editors. Advances in Health care organization theory. San Fransisco: Jossey-Bach; 2003. p. 253–88.
50.
Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, et al. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602–4.CrossRef
Metadata
Title
The conversation matters: a qualitative study exploring the implementation of alcohol screening and brief interventions in antenatal care in Scotland
Authors
Lisa Schölin
Niamh Fitzgerald
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2431-3

Other articles of this Issue 1/2019

BMC Pregnancy and Childbirth 1/2019 Go to the issue

Research article

Male subfertility and the risk of major birth defects in children born after in vitro fertilization and intracytoplasmic sperm injection: a retrospective cohort study

Research article

A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault

Research article

Postpartum depression and associated factors among mothers who gave birth in the last twelve months in Ankesha district, Awi zone, North West Ethiopia

Research article

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

Research article

Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital

Research article

Antenatal care for alcohol consumption during pregnancy: pregnant women’s reported receipt of care and associated characteristics