Abstract / Description of output
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.
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.
| Original language | English |
|---|---|
| Journal | BMC pregnancy and childbirth |
| DOIs | |
| Publication status | Published - 4 Sept 2019 |