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Implementation Science
Published in: Implementation Science 1/2018

Open Access 01-12-2018 | Study protocol

A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial

Authors: Melanie Kingsland, Emma Doherty, Amy E. Anderson, Kristy Crooks, Belinda Tully, Danika Tremain, Tracey W. Tsang, John Attia, Luke Wolfenden, Adrian J. Dunlop, Nicole Bennett, Mandy Hunter, Sarah Ward, Penny Reeves, Ian Symonds, Chris Rissel, Carol Azzopardi, Andrew Searles, Karen Gillham, Elizabeth J. Elliott, John Wiggers

Published in: Implementation Science | Issue 1/2018

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Abstract

Background

Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women.

Methods

The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at ‘booking in’, 27–28 weeks gestation and 35–36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome.

Discussion

This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child.

Trial registrations

Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882​325 (date registered: 16/06/2017).
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Metadata
Title
A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial
Authors
Melanie Kingsland
Emma Doherty
Amy E. Anderson
Kristy Crooks
Belinda Tully
Danika Tremain
Tracey W. Tsang
John Attia
Luke Wolfenden
Adrian J. Dunlop
Nicole Bennett
Mandy Hunter
Sarah Ward
Penny Reeves
Ian Symonds
Chris Rissel
Carol Azzopardi
Andrew Searles
Karen Gillham
Elizabeth J. Elliott
John Wiggers
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-018-0806-x

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