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Talbot H, Peters S, Furber C, Smith DM. Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis. Women Birth 2024; 37:303-316. [PMID: 38195300 DOI: 10.1016/j.wombi.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PROBLEM Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes. BACKGROUND Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes. AIM To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care. METHODS A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage. FINDINGS Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice. CONCLUSION Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.
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Affiliation(s)
- Hannah Talbot
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
| | - Christine Furber
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK
| | - Debbie M Smith
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK
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2
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Dahl B, Johannessen A, Bondas T. Opening Pandora's box: A meta-ethnography about alcohol use in pregnancy from midwives' and other healthcare providers' perspectives. Eur J Midwifery 2023; 7:14. [PMID: 37405231 PMCID: PMC10316433 DOI: 10.18332/ejm/166189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Alcohol consumption has increased in recent years, including among women of childbearing age. A woman's alcohol intake during pregnancy is linked to complications and injuries in the newborn, and the risk of the child being harmed by the mother's alcohol use increases in proportion to the amount of alcohol she consumes. This meta-ethnography aims to explore midwives' and other healthcare providers' experiences of screening pregnant women for alcohol use in pregnancy and counselling them on the subject. METHODS A systematic literature search in CINAHL, Maternity & Infant Care, MEDLINE, and Scopus was conducted in August 2021 and updated in January 2023. The CASP checklist was used to assess the included articles and meta-ethnography was used to synthesize the data. RESULTS Fourteen qualitative studies were included. In the synthesis, we use the metaphor of Pandora's box to deepen our understanding of the topic. We found that some healthcare providers tiptoe around the box, not wanting to face the consequences and responsibilities of asking women about their alcohol use. Others refuse or are reluctant to open the box because they lack knowledge about screening and counselling. Some eventually open the box, understanding the importance of establishing a trusting relationship to address alcohol use and seeing the need for knowledge and screening tools. CONCLUSIONS Healthcare education has the important task of ensuring that healthcare personnel have sufficient evidence-based knowledge about alcohol use in pregnancy. In the future, a health-promoting, tailored approach offering women in pre-pregnancy and early pregnancy sufficient evidence-based information should be implemented.
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Affiliation(s)
- Bente Dahl
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Aud Johannessen
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Terese Bondas
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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3
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Severijns Y, Heijmans MWF, de Die-Smulders CEM, Bijlsma EK, Corsten-Janssen N, Joosten SJR, van Kuijk SMJ, Lichtenbelt KD, Ottenheim CPE, Stuurman KE, Tan-Sindhunata GMB, de Vries H, van Osch LADM. The effects of an online decision aid to support the reproductive decision-making process of genetically at risk couples-A pilot study. J Genet Couns 2023; 32:153-165. [PMID: 36056622 PMCID: PMC10087273 DOI: 10.1002/jgc4.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Couples at risk of transmitting a genetic disease to their offspring may experience doubts about their reproductive options. This study examines the effects of an online decision aid (DA) on the (joint) reproductive decision-making process of couples (not pregnant at time of inclusion) at risk of transmitting a genetic disease to their offspring. The primary outcome is decisional conflict, and secondary outcomes are knowledge, realistic expectations, deliberation, joint informed decision-making, and decisional self-efficacy. These outcomes were measured with a pretest-posttest design: before use (T0), after use (T1), and 2 weeks after use (T2) of the decision aid (DA). Usability of the DA was assessed at T1. Paired sample t-tests were used to compute differences between baseline and subsequent measurements. The comparisons of T0-T1 and T0-T2 indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict scores. Furthermore, use of the DA led to increased knowledge, improved realistic expectations, and increased levels of deliberation, with higher increase in participants with low baseline scores. Decision self-efficacy only improved for participants with lower baseline scores. Participants indicated that the information in the DA was comprehensible and clearly organized. These first results indicate that this online DA is an appropriate tool to support couples at risk of transmitting a genetic disease and a desire to have (a) child(ren) in their reproductive decision-making process.
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Affiliation(s)
- Yil Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maartje W F Heijmans
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nicole Corsten-Janssen
- University of Groningen, University Medical Center Groningen Groningen, Department of Genetics, Groningen, The Netherlands
| | - Sara J R Joosten
- Department of Clinical Genetics, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Klaske D Lichtenbelt
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Kyra E Stuurman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Hein de Vries
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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Pehlke-Milde J, Radu I, Gouilhers S, Hammer R, Meyer Y. Women's views on moderate and low alcohol consumption: stages of the subjective transition from pregnancy to postpartum. BMC Pregnancy Childbirth 2022; 22:902. [PMID: 36464711 PMCID: PMC9721071 DOI: 10.1186/s12884-022-05247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/25/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy and breastfeeding is associated with a risk for the child's healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman's perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period. METHODS The longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth. RESULTS In our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women's perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling. CONCLUSION Many women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.
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Affiliation(s)
- Jessica Pehlke-Milde
- grid.19739.350000000122291644Research Institute of Midwifery, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Irina Radu
- grid.19739.350000000122291644Research Institute of Midwifery, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Solène Gouilhers
- grid.5681.a0000 0001 0943 1999School of Health Sciences (Haute Ecole de Santé Vaud - HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Raphaël Hammer
- grid.5681.a0000 0001 0943 1999School of Health Sciences (Haute Ecole de Santé Vaud - HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Yvonne Meyer
- grid.5681.a0000 0001 0943 1999School of Health Sciences (Haute Ecole de Santé Vaud - HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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5
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Examining socio-cognitive factors and beliefs about mindful eating in healthy adults with differing practice experience: a cross-sectional study. BMC Psychol 2022; 10:268. [PMCID: PMC9664610 DOI: 10.1186/s40359-022-00977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mindful eating (ME), defined as a “non-judgmental awareness of bodily and emotional sensations regarding food consumption”, may be a promising strategy to promote healthy eating behaviors. However, little is known about the psychosocial factors and underlying beliefs that explain ME adoption.
Methods Participants (N = 282; Mage = 43.2) responded to an online questionnaire based on the I-Change Model. Groups with different frequencies of prior engagement in ME, i.e., low (n = 82; LME), medium (n = 96), and high (n = 104), were compared via (M)ANOVAs on factors and individual beliefs regarding predisposing (i.e., habits, experience with mindfulness, emotional eating, facets of ME), pre-motivational (i.e., knowledge, behavioral cognizance, risk perception, cues to action), and motivational factors (i.e., attitudes, self-efficacy, social influence) as well as their intentions and action planning. Bivariate correlations and a forward-stepwise regression with ICM constructs were conducted to examine model fit. Results LME had a greater habit of mindless eating and significantly lower internal awareness, cognizance, cues, and less favorable attitudes, self-efficacy, engagement and support by their social environment, intention, and action plans about engaging in ME than the other two groups. Less habitual mindless eating, and greater experience, internal awareness, cognizance, susceptibility, support, and intention explained 54% of the variance in ME. Discussion and conclusion Results indicate that individuals need to be treated differently when promoting ME with respect to their psychosocial characteristics, rather than as a single group with homogenous baseline beliefs, abilities, support, and motivation. Future longitudinal research should examine which determinants are predictors of ME to better tailor program contents. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00977-4.
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Kotelnikova Z. Prevalence of self-reported alcohol consumption among pregnant women in Russia between 1994 and 2018. Alcohol Clin Exp Res 2022; 46:825-835. [PMID: 35238058 DOI: 10.1111/acer.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 02/04/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although pregnant women in Russia are thought to have a high level of alcohol consumption, nationwide data have not been available. We compared changes in consumption among pregnant and nonpregnant women of childbearing age from 1994 to 2018 and examined predictors of consumption among the pregnant women. METHODS Data were obtained from the annual, nationally representative Russian Longitudinal Monitoring Survey (RLMS-HSE), comprising 1,943 pregnant and 80,237 nonpregnant women of childbearing age. Past 30-day alcohol prevalence and current pregnancy status were self-reported. Logistic regressions using generalized linear mixed models examined two dependent variables: (1) current drinkers (any alcohol in the past 30 days) versus nondrinkers and (2) current drinkers and occasional drinkers (ever drinkers at any level) versus nondrinkers. Analyses included a series of predictors and control variables. RESULTS Between 1994 and 2018, a decrease in the 30-day prevalence of alcohol consumption was observed in both pregnant (from 25.6 (95% CI ± 3.3) to 9.4% (95% CI ± 2.2)) and nonpregnant (from 57.3 (95% CI ± 0.7) to 39.0% (95% CI ± 0.6)) women. Between 2006 and 2018, the percentage of pregnant abstainers increased from 46.8% (95% CI ± 4.2) to 54.6% (95% CI ± 3.6) while occasional drinking among pregnant women remained at 35% (95% CI ± 4.0). Time period, preventative check-ups, hospitalization, and frequent doctor's visits were significant predictors of the decrease in the 30-day prevalence of alcohol intake in pregnant women, but these did not predict the prevalence of occasional drinking. CONCLUSION Despite significant reductions in consumption among pregnant women in Russia, a substantial proportion reported occasional drinking. Conflicting information on how low alcohol intake affects health risks limited efforts to promote abstinence. Occasional drinking reflects a self-control domain for women that, depending on perceptions of a healthy pregnancy, is framed by social institutions and the environment.
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Affiliation(s)
- Zoya Kotelnikova
- Laboratory for Studies in Economic Sociology, HSE University, Moscow, Russia
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Women's views and experiences of occasional alcohol consumption during pregnancy: A systematic review of qualitative studies and their recommendations. Midwifery 2022; 111:103357. [DOI: 10.1016/j.midw.2022.103357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 11/23/2021] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
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Okulicz-Kozaryn K. Is Public Health Response to the Phenomenon of Alcohol Use during Pregnancy Adequate to the Polish Women’s Needs? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084552. [PMID: 35457420 PMCID: PMC9025347 DOI: 10.3390/ijerph19084552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Due to the risks it poses to a child’s health, drinking alcohol during pregnancy is a serious problem that the public health sector is struggling to deal with. The reasons why women who do not have alcohol problems do not give up drinking alcohol completely during pregnancy are still poorly understood. And the knowledge available about them does not translate into communication strategies in Poland. The analysis of standards and examples of good practice allows to formulate proposals for improving the quality and effectiveness of social campaigns addressed to the general population and women of childbearing age in order to reduce the risk associated with the prenatal exposure to alcohol.
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Affiliation(s)
- Katarzyna Okulicz-Kozaryn
- Institute of Mother and Child, 01-211 Warsaw, Poland;
- National Centre for Prevention of Addictions, 02-776 Warsaw, Poland
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9
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“Now, with a bit more knowledge, I understand why I'm asking those questions.” Midwives’ perspectives on their role in the Greater Manchester Health and Social Care Partnership's programme to Reduce Alcohol Exposed Pregnancies (AEP). Midwifery 2022; 110:103335. [DOI: 10.1016/j.midw.2022.103335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 11/22/2022]
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10
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Experiences of pregnant women and healthcare professionals of participating in a digital antenatal CMV education intervention. Midwifery 2022; 106:103249. [PMID: 35032932 PMCID: PMC8850414 DOI: 10.1016/j.midw.2022.103249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
Objective The study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood. Design This process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews. Setting Recruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London Participants The study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy. Findings Pregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women. Key conclusions and implications for practice There is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.
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Severijns Y, van der Linden H, de Die-Smulders CEM, Hoving C, Jansen J, van Osch LADM. To what extent do decision aids for prenatal screening and diagnosis address involvement of partners in decision-making? - An environmental scan. PATIENT EDUCATION AND COUNSELING 2021; 104:2952-2962. [PMID: 33941420 DOI: 10.1016/j.pec.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Numerous decision aids (DAs) have been developed to inform pregnant people about prenatal screening as the decision whether or not to accept the prenatal screening offer may be difficult. Currently, little is known about the role of the decisional partner of the pregnant people in this decision-making process and to what extent DAs involve and engage the partner. METHODS A broad search was conducted to identify publicly available DAs in English and/or Dutch regarding prenatal screening and diagnosis. These DAs were analysed on aspects of partner involvement. RESULTS Ten of the 19 identified DAs (52.6%) contained at least one aspect of partner involvement. Several DAs acknowledged that both partners should be involved in the decision (n = 7). The content that was least likely to contain aspects of partner involvement in the DA was value clarification content (n = 2) and only one DA contained content with plural addressing. CONCLUSION Just over half of the included DAs included some aspect(s) of partner involvement. PRACTICAL IMPLICATIONS More research is needed to determine to what extent, and how, the partner should be involved in the decision-making process as expectant people consider the input of their partner as important.
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Affiliation(s)
- Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, the Netherlands.
| | - H van der Linden
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands
| | - C E M de Die-Smulders
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre+, the Netherlands
| | - C Hoving
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands
| | - J Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, the Netherlands
| | - L A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre+, the Netherlands
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Lima-Serrano M, Fernández-León P, Mercken L, Martínez-Montilla JM, de Vries H. An Animation- Versus Text-Based Computer-Tailored Game Intervention to Prevent Alcohol Consumption and Binge Drinking in Adolescents: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9978. [PMID: 34639280 PMCID: PMC8508351 DOI: 10.3390/ijerph18199978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this paper is to describe the protocol for the design, implementation, and evaluation of an animation- versus text-based computer tailoring game intervention aimed at preventing alcohol consumption and binge drinking (BD) in adolescents. A cluster-randomized controlled trial (CRCT) is carried out in students aged 14-19 enrolled in 24 high schools from Andalusia (Spain), which are randomized either to experimental (EC-1, EC-2) or waiting-list control conditions (CC). EC-1 receives an online intervention (Alerta Alcohol) with personalized health advice, using textual feedback and several gamification techniques. EC-2 receives an improved version (Alerta Alcohol 2.0) using animated videos and new gamification strategies. Both programs consist of nine sessions (seven taking place at high school and two at home): session 1 or baseline, sessions 2 and 3 that provide tailored advice based on the I-Change Model; sessions 4, 5, 7, and 8 are booster sessions, and sessions 6 and 9 are follow-up questionnaires at six and twelve months. The CC completes the baseline and the evaluation questionnaires. The primary outcome is BD within 30 days before post-test evaluations, and as secondary outcomes we assess other patterns of alcohol use. The findings should help the development of future alcohol drinking prevention interventions in adolescents.
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Affiliation(s)
- Marta Lima-Serrano
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| | - Pablo Fernández-León
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 HA Maastricht, The Netherlands; (L.M.); (H.d.V.)
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 HA Maastricht, The Netherlands; (L.M.); (H.d.V.)
- Department of Health Psychology, Open University Heerlen, 6419 AT Heerlen, The Netherlands
| | | | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6229 HA Maastricht, The Netherlands; (L.M.); (H.d.V.)
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Mothupi MC, De Man J, Tabana H, Knight L. Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa. PLoS One 2021; 16:e0252182. [PMID: 34033670 PMCID: PMC8148336 DOI: 10.1371/journal.pone.0252182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. MATERIALS AND METHODS The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. RESULTS The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. CONCLUSIONS This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.
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Affiliation(s)
- Mamothena Carol Mothupi
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Jeroen De Man
- Department of Primary and Interdisciplinary Care, Centre for General Practice, University of Antwerp, Antwerp, Belgium
| | - Hanani Tabana
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lucia Knight
- School of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Wouldes TA, Crawford A, Stevens S, Stasiak K. Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women. Front Psychiatry 2021; 12:634805. [PMID: 34025470 PMCID: PMC8131659 DOI: 10.3389/fpsyt.2021.634805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.
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Affiliation(s)
- Trecia A. Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andi Crawford
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Te Ara Manapou, Parenting and Pregnancy Service, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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15
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Breunis LJ, Wassenaar S, Sibbles BJ, Aaldriks AA, Bijma HH, Steegers EAP, Koch BCP. Objective assessment of alcohol consumption in early pregnancy using phosphatidylethanol: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:342. [PMID: 33931032 PMCID: PMC8086351 DOI: 10.1186/s12884-021-03804-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol consumption during pregnancy is associated with major birth defects and developmental disabilities. Questionnaires concerning alcohol consumption during pregnancy underestimate alcohol use while the use of a reliable and objective biomarker for alcohol consumption enables more accurate screening. Phosphatidylethanol can detect low levels of alcohol consumption in the previous two weeks. In this study we aimed to biochemically assess the prevalence of alcohol consumption during early pregnancy using phosphatidylethanol in blood and compare this with self-reported alcohol consumption. Methods To evaluate biochemically assessed prevalence of alcohol consumption during early pregnancy using phosphatidylethanol levels, we conducted a prospective, cross-sectional, single center study in the largest tertiary hospital of the Netherlands. All adult pregnant women who were under the care of the obstetric department of the Erasmus MC and who underwent routine blood testing at a gestational age of less than 15 weeks were eligible. No specified informed consent was needed. Results The study was conducted between September 2016 and October 2017. In total, we received 1,002 residual samples of 992 women. After applying in- and exclusion criteria we analyzed 684 samples. Mean gestational age of all included women was 10.3 weeks (SD 1.9). Of these women, 36 (5.3 %) tested positive for phosphatidylethanol, indicating alcohol consumption in the previous two weeks. Of women with a positive phosphatidylethanol test, 89 % (n = 32) did not express alcohol consumption to their obstetric care provider. Conclusions One in nineteen women consumed alcohol during early pregnancy with a high percentage not reporting this use to their obstetric care provider. Questioning alcohol consumption by an obstetric care provider did not successfully identify (hazardous) alcohol consumption. Routine screening with phosphatidylethanol in maternal blood can be of added value to identify women who consume alcohol during pregnancy.
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Affiliation(s)
- Leonieke J Breunis
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Sophie Wassenaar
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Barbara J Sibbles
- Department of Pediatrics, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Ab A Aaldriks
- Department of Psychiatry, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Hilmar H Bijma
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
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16
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Schölin L, Watson J, Dyson J, Smith LA. Midwives' views on alcohol guidelines: A qualitative study of barriers and facilitators to implementation in UK antenatal care. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100628. [PMID: 33946025 DOI: 10.1016/j.srhc.2021.100628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Midwives play an important role in health promotion and prevention of alcohol-related harm, but previous research has suggested that although most midwives report advising on abstinence, evidence exist that women are informed that "some" alcohol is not harmful. The aim of this qualitative study was to explore midwives' views on implementation of the 2016 Chief Medical Officers' alcohol guidelines in antenatal care in the UK. METHODS Focus groups and individual interviews with 22 midwives working in maternity and educational settings in the UK were conducted either in person or over telephone. Data were subjected to thematic analysis. RESULTS Conflict between guidelines from different sources and lack of knowledge of the abstinence advice issued in the Guidelines were barriers to discussing abstinence. Communication with women and building relationships were key facilitators supporting alcohol discussions. How alcohol was addressed appeared to vary across the UK with no uniform approach. Building a trusted relationship was believed to be the way in which women can disclose alcohol use, though the first antenatal contact was not always viewed as the best time to discuss what was considered a personal matter. CONCLUSION Despite the release of new guidance in 2016, there was little recognition and awareness of these among midwives. Midwives were by default guided by other national clinical sources or guidelines. Future research should explore how practice-based interventions can address systemic and interpersonal factors to support health professionals to implement the Guidelines, and ensure that women are provided support to change unhealthy behaviours.
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Affiliation(s)
- Lisa Schölin
- Nursing Studies, School of Health in Social Science, Old Medical School, University of Edinburgh, Teviot Place, EH9 8AG Edinburgh, United Kingdom.
| | - Julie Watson
- Department of Midwifery and Child, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Judith Dyson
- Institute of Clinical Applied Health Research, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
| | - Lesley A Smith
- Institute of Clinical Applied Health Research, Faculty of Health Sciences, University of Hull, Hull HU6 7RX, United Kingdom
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17
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Lyall V, Wolfson L, Reid N, Poole N, Moritz KM, Egert S, Browne AJ, Askew DA. "The Problem Is that We Hear a Bit of Everything…": A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3445. [PMID: 33810338 PMCID: PMC8037183 DOI: 10.3390/ijerph18073445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
Understanding the factors that contribute to women's alcohol use in pregnancy is critical to supporting women's health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada's Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women's alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.
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Affiliation(s)
- Vivian Lyall
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
| | - Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Natasha Reid
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Karen M. Moritz
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
- School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Deborah A. Askew
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
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18
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Smith LA, Dyson J, Watson J, Schölin L. Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives. BMC Pregnancy Childbirth 2021; 21:134. [PMID: 33588774 PMCID: PMC7885406 DOI: 10.1186/s12884-021-03583-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03583-1.
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Affiliation(s)
- Lesley A Smith
- Institute of Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Judith Dyson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Julie Watson
- Care Quality Commission, Citygate, Gallowgate, Newcastle Upon Tyne, NE1 4PA, UK
| | - Lisa Schölin
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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19
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Prevalence of Alcohol and Tobacco Use and Perceptions Regarding Prenatal Care among Pregnant Brazilian Women, 2017 to 2018: A Mixed-Methods Study. Matern Child Health J 2020; 24:1438-1445. [PMID: 33009981 DOI: 10.1007/s10995-020-03012-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify the prevalence of alcohol and tobacco drug use among pregnant women and investigate their perceptions regarding advice from health professionals during prenatal care. METHOD We used a sequential explanatory mixed-methods design for this cross-sectional study; the study period was January 2017 to December 2018. Multistage random sampling resulted in the selection of 255 pregnant women assisted in primary care units and through the Family Health Strategy in a city in southern Brazil. Trained interviewers collected data on the use of alcohol and tobacco drugs and socioeconomic characteristics via a questionnaire. Qualitative interviews were performed with pregnant women identified as alcohol and tobacco drug users in the quantitative phase. Interviews proceeded consecutively until saturation was reached, followed by a thematic analysis of interview content based on Braun and Clarke. RESULTS The prevalence of smoking and alcohol use was 12.55% and 14.12%, respectively. From the 14 interviews conducted, five categories emerged from the discourses: prenatal care from the perspective of pregnant women, habits and knowledge regarding smoking during pregnancy, habits and knowledge regarding alcohol use during pregnancy, previous experiences and empirical knowledge, and pregnant women's preferences for talking about their habits. CONCLUSION FOR PRACTICE Study findings identified smoking and alcohol use as habits among some women during pregnancy and, consequently, the need for improving care because of their superficial knowledge regarding tobacco and alcohol use. The findings underscore the importance of strengthening measures and establishing new strategies that ensure women's understanding, empowerment, and choices-from the beginning of childbearing age-regarding habits during pregnancy.
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20
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Jattamart A, Leelasantitham A. Perspectives to social media usage of depressed patients and caregivers affecting to change the health behavior of patients in terms of information and perceived privacy risks. Heliyon 2020; 6:e04244. [PMID: 32613120 PMCID: PMC7322135 DOI: 10.1016/j.heliyon.2020.e04244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/17/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022] Open
Abstract
It has been confirmed that the use of social media (SM) can affect the mental health of users. However, there is no explanation for its impact on health behavior. This study focuses on the perspectives of depressed patients and caregivers on social media usage and how it can change their health behavior. A questionnaire designed according to the framework of the I-Change Model (ICM) is used to collect data from a sample group. This group consists of 214 patients diagnosed with major depressive disorders, and 110 caregivers. The data is used to analyze causal relationships with the help of structural equation modeling. The results showed that from the patient's perspective it is essential to be aware of the content and volume of social media usage. An awareness of the perceived risk to privacy is also essentially a motivating factor in patients' decisions to use social media. The views of caregivers suggest that content valence has an essential role to play in their use of social media. After viewing content on social media patients change their behavior. The perceived privacy risk also plays a critical role in patients' decisions to use social media.
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Affiliation(s)
- Aungkana Jattamart
- Technology of Information System Management Division, Faculty of Engineering, Mahidol University, Nakhonpathom, Thailand
| | - Adisorn Leelasantitham
- Technology of Information System Management Division, Faculty of Engineering, Mahidol University, Nakhonpathom, Thailand
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21
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Why are Spanish Adolescents Binge Drinkers? Focus Group with Adolescents and Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103551. [PMID: 32438735 PMCID: PMC7277407 DOI: 10.3390/ijerph17103551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
Binge drinking in adolescents is a worldwide public healthcare problem. The aim of this study was to explore the perceptions about determinants of binge drinking in Spanish adolescents from the perspective of adolescents and parents. A qualitative study using fourteen semi-structured focus groups of adolescents was conducted during the 2014/2015 school year (n = 94), and four with parents (n = 19), based on the I-Change Model for health behaviour acquisition. Students had a low level of knowledge and risk perception and limited self-efficacy. Girls reported more parental control, and when they get drunk, society perceives them worse. Adolescents suggested focus preventive actions to improve self-efficacy and self-esteem. Parents were permissive about alcohol drinking but rejected binge drinking. They offered alcohol to their children, mainly during celebrations. A permissive family environment, lack of control by parents, adolescents’ low-risk perception, low self-esteem and self-efficacy, as well as the increase of binge drinking in girls as part of the reduction of the gender gap, emerge as risk factors for binge drinking. Future health programmes aimed at reducing binge drinking should focus on enhancing motivational factors, self-esteem, and self-efficacy in adolescents; supervision and parental control; as well as pre-motivational factors by increasing knowledge and risk awareness, considering gender differences.
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22
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Schölin L, Hughes K, Bellis MA, Eriksson C, Porcellato L. “I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2018.1478949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lisa Schölin
- Liverpool John Moores Unviersity, Public Health Institute, Henry Cotton Campus, Liverpool, UK
| | - Karen Hughes
- Public Health Wales Directorate of Policy Research and International Development Public Health Wales, Wrexham, UK
- Bangor University College of Health and Behavioural Sciences, Bangor, UK
| | - Mark A. Bellis
- Public Health Wales Directorate of Policy Research and International Development Public Health Wales, Wrexham, UK
- Bangor University College of Health and Behavioural Sciences, Bangor, UK
| | - Charli Eriksson
- School of Health and Medical Sciences, Örebro Universitet, Örebro, Sweden
| | - Lorna Porcellato
- Liverpool John Moores Unviersity, Public Health Institute, Henry Cotton Campus, Liverpool, UK
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23
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Doherty E, Wiggers J, Wolfenden L, Anderson AE, Crooks K, Tsang TW, Elliott EJ, Dunlop AJ, Attia J, Dray J, Tully B, Bennett N, Murray H, Azzopardi C, Kingsland M. Antenatal care for alcohol consumption during pregnancy: pregnant women's reported receipt of care and associated characteristics. BMC Pregnancy Childbirth 2019; 19:299. [PMID: 31419964 PMCID: PMC6698023 DOI: 10.1186/s12884-019-2436-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background Antenatal clinical guidelines recommend that during initial and subsequent antenatal visits all pregnant women: have their alcohol consumption assessed; be advised that it is safest not to consume alcohol during pregnancy and of the potential risks of consumption; and be offered referrals for further support if required. However, the extent to which pregnant women attending public antenatal services receive guideline recommended care at these visits, and the characteristics associated with its receipt, is unknown. The purpose of this study was to examine: 1) pregnant women’s reported receipt of guideline recommended care addressing alcohol consumption during pregnancy; 2) characteristics associated with the receipt of care; and 3) pregnant women’s acceptability of care. Methods From July 2017 – February 2018 a survey (telephone or online) was undertaken with 1363 pregnant women who had recently visited a public antenatal service in one health district in Australia. Receipt and acceptability of recommended care were assessed via descriptive statistics and associations via logistic regression analyses. Results At the initial antenatal visit, less than two thirds (64.3%) of pregnant women reported that they received an assessment of their alcohol consumption and just over one third (34.9%) received advice and referral appropriate to their self-reported level of alcohol consumption since pregnancy recognition. Less than 10% of women received such care at subsequent antenatal visits. Characteristics that significantly increased the odds of receiving all guideline elements at the initial antenatal visit included: less than university attainment (OR = 1.93; 95% CI:1.12, 3.34), not residing in an advantaged area (OR = 2.11; 95% CI:1.17, 3.79), first pregnancy (OR = 1.91; 95% CI:1.22, 2.99) and regional/rural service location (OR = 2.38; 95% CI:1.26, 4.48); and at subsequent visits: younger age (OR = 0.91; 95% CI:0.84, 0.99) and Aboriginal origin (OR = 3.17; 95% CI:1.22, 8.24). Each of the recommended care elements were highly acceptable to pregnant women (88.3–99.4%). Conclusions Although care for alcohol consumption is both recommended by clinical guidelines and highly acceptable to pregnant women, its receipt in public antenatal services is suboptimal. There is a need and an opportunity for interventions to support antenatal care providers to routinely and consistently provide such care to all pregnant women.
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Affiliation(s)
- Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia Dray
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Nicole Bennett
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Henry Murray
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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24
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Chiodo LM, Cosmian C, Pereira K, Kent N, Sokol RJ, Hannigan JH. Prenatal Alcohol Screening During Pregnancy by Midwives and Nurses. Alcohol Clin Exp Res 2019; 43:1747-1758. [PMID: 31184777 PMCID: PMC6772020 DOI: 10.1111/acer.14114] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use during pregnancy can have a variety of harmful consequences on the fetus. Lifelong effects include growth restriction, characteristic facial anomalies, and neurobehavioral dysfunction. This range of effects is known as fetal alcohol spectrum disorders (FASD). There is no amount, pattern, or timing of alcohol use during pregnancy proven safe for a developing embryo or fetus. Therefore, it is important to screen patients for alcohol use, inform them about alcohol's potential effects during pregnancy, encourage abstinence, and refer for intervention if necessary. However, how and how often nurses and midwives inquire about alcohol drinking during pregnancy or use recommended screening tools and barriers they perceive to alcohol screening has not been well established. METHODS This survey was sent to about 6,000 American midwives, nurse practitioners, and nurses who provide prenatal care about their knowledge of the effects of prenatal alcohol exposure, the prevalence of alcohol use during pregnancy, and practices for screening patients' alcohol use. Participants were recruited by e-mail from the entire membership roster of the American College of Nurse-Midwives. RESULTS There were 578 valid surveys returned (about 9.6%). Analyses showed that 37.7% of the respondents believe drinking alcohol is safe during at least one trimester of pregnancy. Only 35.2% of respondents reported screening to assess patient alcohol use. Only 23.3% reported using a specific screening tool, and few of those were validated screens recommended for use in pregnant women. Respondents who believe alcohol is safe at some point in pregnancy were significantly less likely to screen their patients. CONCLUSIONS Respondents who reported that pregnancy alcohol use is unsafe felt more prepared to educate and intervene with patients regarding alcohol use during pregnancy and FASD than respondents who reported drinking in pregnancy was safe. Perceived alcohol safety and perceived barriers to screening appeared to influence screening practices. Improving prenatal care provider knowledge about the effects of prenatal alcohol exposure and the availability of valid alcohol screening tools will improve detection of drinking during pregnancy, provide more opportunities for meaningful intervention, and ultimately reduce the incidence of FASD.
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Affiliation(s)
- Lisa M. Chiodo
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Caitlin Cosmian
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Kristy Pereira
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Nicole Kent
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Robert J. Sokol
- Department of Obstetrics & GynecologyWayne State UniversityDetroitMichigan
- C.S. Mott Center for Human Growth & DevelopmentWayne State UniversityDetroitMichigan
| | - John H. Hannigan
- Department of Obstetrics & GynecologyWayne State UniversityDetroitMichigan
- C.S. Mott Center for Human Growth & DevelopmentWayne State UniversityDetroitMichigan
- Merrill Palmer Skillman Institute for Child and Family DevelopmentWayne State UniversityDetroitMichigan
- Department of PsychologyWayne State UniversityDetroitMichigan
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Fergie L, Campbell KA, Coleman-Haynes T, Ussher M, Cooper S, Coleman T. Identifying Effective Behavior Change Techniques for Alcohol and Illicit Substance Use During Pregnancy: A Systematic Review. Ann Behav Med 2019; 53:769-781. [PMID: 30379989 PMCID: PMC6636888 DOI: 10.1093/abm/kay085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND During pregnancy, consuming alcohol and using illicit drugs can have serious health implications for both mother and child. Behavioral change interventions, especially those underpinned by theoretical constructs, can be effective in reducing harmful substance use among pregnant women. PURPOSE To understand what type of behavior change mechanisms could be useful in reducing alcohol consumption or achieving abstinence from illicit drug use during pregnancy, this review aimed to identify behavior change techniques (BCTs), the smallest, active components of interventions that may be effective. It also aimed to establish the extent that psychosocial-based theories were used to inform intervention design. METHODS To identify eligible randomized controlled trials (RCTs), five databases were searched electronically from the end search dates of the most recent Cochrane systematic reviews on behavioral interventions for each behavior, until March 2018. Within the RCTs, intervention descriptions were analyzed for BCT content and extent of theory use in the intervention design process and outcome measurements, in each trial, was established. "Effectiveness percentages," the number of times a BCT had been a component of an effective intervention divided by the total number of interventions it had been used in, were calculated for BCTs used in two or more trials. RESULTS Including all RCTs from the Cochrane reviews, and those published subsequently, nine alcohol and six illicit drug trials were identified. Interventions tested in four alcohol RCTs and no illicit drugs RCTs showed positive results. Subsequent data were extracted for alcohol consumption trials only. Thirteen BCTs showed "potential effectiveness" for alcohol consumption. Six of nine included alcohol trials reported using theory but not extensively. CONCLUSIONS Action planning, behavioral contract, prompts/cues, self-talk, offer/direct toward written material, problem solving, feedback on behavior, social support (unspecified), information about health consequences, behavior substitution, assess current readiness and ability to reduce excess alcohol consumption, goal setting (behavior), and tailor interactions appropriately are BCTs that could be useful in helping reduce alcohol consumption among pregnant women.
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Affiliation(s)
- Libby Fergie
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Katarzyna A Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Schölin L, Hughes K, Bellis MA, Eriksson C, Porcellato L. Exploring practices and perceptions of alcohol use during pregnancy in England and Sweden through a cross-cultural lens. Eur J Public Health 2019; 28:533-537. [PMID: 29206945 DOI: 10.1093/eurpub/ckx208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden. Methods Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in Örebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis. Results The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks. Conclusions Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not.
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Affiliation(s)
- Lisa Schölin
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.,Public Health Institute, Liverpool John Moores University, 15-21 Webster Street, Liverpool, UK
| | - Karen Hughes
- Public Health Wales, Hadyn Ellis Building, Cardiff University, Maindy Road, Cardiff, UK
| | - Mark A Bellis
- Public Health Wales, Hadyn Ellis Building, Cardiff University, Maindy Road, Cardiff, UK
| | - Charli Eriksson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Lorna Porcellato
- Public Health Institute, Liverpool John Moores University, 15-21 Webster Street, Liverpool, UK
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The influence of pre-motivational factors on behavior via motivational factors: a test of the I-Change model. BMC Psychol 2019; 7:7. [PMID: 30786921 PMCID: PMC6381617 DOI: 10.1186/s40359-019-0283-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/13/2019] [Indexed: 02/03/2023] Open
Abstract
Background The I-Change Model for explaining motivational and behavioral change postulates that an awareness phase precedes the motivation phase of a person, and that effects of pre-motivational factors on behavior are partially mediated by motivational factors. This study tests this assumption with regard to physical activity. Methods Observational longitudinal survey study (baseline, three months, six months) amongst Dutch adults (N = 2434). Structural equation modelling was used to investigate whether the influence of (1) knowledge, (2) cognizance, (3) cues, and (4) risk perception separately on intention and physical activity were mediated by motivational factors (i.e. attitudes, self-efficacy and social influence). Subsequently, a comprehensive model including all pre-motivational factors was estimated to test the same assumption for all pre-motivational factors simultaneously. Results The results indicate that the associations of cognizance, risk perception and cues with behavior were fully mediated by motivational factors when tested separately. When tested simultaneously only the effect of cognizance remained. Cognizance was most strongly associated with positive attitudes β = .13, p < .01, self-efficacy β = .13, p < .01, and intention β = .14, p < .01. No direct link with behavior was found. Conclusion The results suggest that pre-motivational factors are important to form a motivation; however, they do not directly influence behavior. The inclusion of factors such as risk perception and cognizance would help to get a better understanding of motivation formation and behavior.
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Grant A, Morgan M, Mannay D, Gallagher D. Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model. BMC Pregnancy Childbirth 2019; 19:56. [PMID: 30744581 PMCID: PMC6371518 DOI: 10.1186/s12884-018-2156-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy. METHODS The study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants' thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation - Behaviour). RESULTS Five participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women's behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours. CONCLUSIONS When designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women's subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.
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Affiliation(s)
- Aimee Grant
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Melanie Morgan
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Dawn Mannay
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT UK
| | - Dunla Gallagher
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK Ireland
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Oni HT, Buultjens M, Abdel-Latif ME, Islam MM. Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis. Women Birth 2018; 32:479-486. [PMID: 30528816 DOI: 10.1016/j.wombi.2018.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Maternal alcohol or other drug use during pregnancy is associated with a range of adverse health outcomes for mothers and their unborn child. The antenatal period presents an opportunity for health professionals to offer routine screening for alcohol or other drugs, to then provide intervention and referral for treatment and/or specialised support services. However, literature indicates that limited screening practices currently exist in maternity care settings. AIM To identify barriers to screening pregnant women for alcohol or other drugs in maternity care settings, from the perspectives of healthcare professionals. METHODS A comprehensive literature search was conducted in October 2017 to identify relevant studies. Seven databases that index health and social sciences literature, and google scholar, were searched. Eligible articles were subjected to critical appraisal. Extracted data from the eligible studies were synthesised using narrative synthesis. FINDINGS Nine studies were eligible for this review. The review identified seven key barriers to screening for alcohol or other drugs in pregnancy, namely competing priorities and time constraint; lack of adequate screening skills and clear protocol; relationship between healthcare providers and pregnant women; healthcare providers' perceptions; under-reporting or none/false disclosure; inconclusive evidence regarding the risk of alcohol or other drug use in pregnancy; and concerns about guilt and anxiety. CONCLUSIONS The narrative review revealed a range of barriers to screening for alcohol or other drugs in pregnancy. Further research in minimising the barriers is required to establish women-centred, evidence-base screening practices.
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Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia.
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
| | | | - M Mofizul Islam
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
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Howlett H, Gray WK, Dismore L, Mackenzie S, Langley K, Davidson C, Rankin J. A survey of attitudes, beliefs and practice regarding alcohol use and screening in pregnancy: an opportunity for support and education? J Res Nurs 2017. [DOI: 10.1177/1744987117745579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing antenatal and postnatal support for women who drink alcohol in pregnancy is only possible if those at risk can be identified. However, screening will only be helpful if women feel comfortable with the method used. We conducted a survey of pregnant women and their partners to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. Pregnant women and their partners attending antenatal clinics in North-East England were asked to complete a short survey regarding their alcohol consumption in pregnancy, their beliefs about safe levels of alcohol in pregnancy and whether they would be happy to have their blood or their baby’s meconium analysed for alcohol biomarkers. The data were summarised using descriptive statistics and thematic analysis. A total of 171 pregnant women and 41 partners participated. Of the pregnant women, 153 (89.5%) felt women should abstain from alcohol consumption, although only 70 (40.9%) reported not drinking in pregnancy. Of 96 women who reported drinking in pregnancy and reported when they stopped, all but six (6.3%) stopped drinking when they found out they were pregnant. Of women and partners who recorded an answer, 177 (87.2%) said they would consent to blood biomarker analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear.
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Affiliation(s)
- Helen Howlett
- Nurse & Midwife Researcher, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - William K Gray
- Senior Research Associate and Statistician, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Lorelle Dismore
- Assistant Psychologist, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Shonag Mackenzie
- Consultant Obstetrician, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, UK
| | - Kate Langley
- Medical Student, The Medical School, Newcastle University, UK
| | | | - Judith Rankin
- Professor of Maternal & Perinatal Epidemiology, Institute of Health and Society, Newcastle University, UK
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Voncken-Brewster V, Amoureus M, de Vries H, Nagykaldi Z, Winkens B, van der Weijden T, Tange H. The Impact of Participant Characteristics on Use and Satisfaction of a Web-Based Computer-Tailored Chronic Obstructive Pulmonary Disease Self-Management Intervention: A Process Evaluation. JMIR Form Res 2017; 1:e1. [PMID: 30684399 PMCID: PMC6334693 DOI: 10.2196/formative.6585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND A randomized controlled trial (RCT) showed that a Web-based computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease (COPD) did not have a significant treatment effect. Process evaluation measures such as application use and satisfaction with the intervention can help understand these results. OBJECTIVES The aim of this paper is to uncover reasons for suboptimal application use, evaluate satisfaction with the intervention, and investigate which participant characteristics predict application use and user satisfaction. METHODS Participants were recruited through 2 different channels: an online panel and general practice. The intervention group received the intervention, which consisted of 2 modules (smoking cessation and physical activity). The control group received no intervention. The study employed a mixed methods design. Quantitative and qualitative data were gathered assessing participant characteristics, application use, reasons for not using the application, and satisfaction with the intervention. RESULTS The RCT included 1325 participants. The proportion of individuals who participated was significantly higher in the online group (4072/6844, 59.5%) compared to the general practice group (43/335, 12.8%) (P<.001). Application use was low. Of all participants in the intervention group, 52.9% (348/658) initiated use of one or both modules, 36.0% (237/658) completed an intervention component (prolonged use), and 16.6% (109/658) revisited one of the modules after completing an intervention component (sustained use). Older age, established diagnosis of COPD, or experiencing breathlessness predicted sustained use. Participant satisfaction with the 2 modules was 6.7 (SD 1.6) on a scale from 0 to 10. The interviews revealed that a computer application was believed not to be sufficient and the help of a health care professional was necessary. Participants with a greater intention to change were more satisfied with the application. CONCLUSIONS The application was not used sufficiently. Study materials should be further tailored to younger individuals, those at risk for COPD, and those who do not experience breathlessness in order to increase sustained use among them. Involvement of a health care professional could improve satisfaction with the intervention and potentially increase engagement with the intervention materials. However, to make this possible, recruitment in general practice needs to be improved. Recommendations are made for improving the study design, strengthening the intervention (eg, practice facilitation), and linking the computer application to interaction with a health care provider.
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Affiliation(s)
- Viola Voncken-Brewster
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mylène Amoureus
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Zsolt Nagykaldi
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma, OK, United States
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Huibert Tange
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
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Voncken-Brewster V, Amoureus M, de Vries H, Nagykaldi Z, Winkens B, van der Weijden T, Tange H. The Impact of Participant Characteristics on Use and Satisfaction of a Web-Based Computer-Tailored Chronic Obstructive Pulmonary Disease Self-Management Intervention: A Process Evaluation. JMIR Form Res 2017. [PMID: 30684399 PMCID: PMC6334693 DOI: 10.2196//formative.6585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A randomized controlled trial (RCT) showed that a Web-based computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease (COPD) did not have a significant treatment effect. Process evaluation measures such as application use and satisfaction with the intervention can help understand these results. OBJECTIVES The aim of this paper is to uncover reasons for suboptimal application use, evaluate satisfaction with the intervention, and investigate which participant characteristics predict application use and user satisfaction. METHODS Participants were recruited through 2 different channels: an online panel and general practice. The intervention group received the intervention, which consisted of 2 modules (smoking cessation and physical activity). The control group received no intervention. The study employed a mixed methods design. Quantitative and qualitative data were gathered assessing participant characteristics, application use, reasons for not using the application, and satisfaction with the intervention. RESULTS The RCT included 1325 participants. The proportion of individuals who participated was significantly higher in the online group (4072/6844, 59.5%) compared to the general practice group (43/335, 12.8%) (P<.001). Application use was low. Of all participants in the intervention group, 52.9% (348/658) initiated use of one or both modules, 36.0% (237/658) completed an intervention component (prolonged use), and 16.6% (109/658) revisited one of the modules after completing an intervention component (sustained use). Older age, established diagnosis of COPD, or experiencing breathlessness predicted sustained use. Participant satisfaction with the 2 modules was 6.7 (SD 1.6) on a scale from 0 to 10. The interviews revealed that a computer application was believed not to be sufficient and the help of a health care professional was necessary. Participants with a greater intention to change were more satisfied with the application. CONCLUSIONS The application was not used sufficiently. Study materials should be further tailored to younger individuals, those at risk for COPD, and those who do not experience breathlessness in order to increase sustained use among them. Involvement of a health care professional could improve satisfaction with the intervention and potentially increase engagement with the intervention materials. However, to make this possible, recruitment in general practice needs to be improved. Recommendations are made for improving the study design, strengthening the intervention (eg, practice facilitation), and linking the computer application to interaction with a health care provider.
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Affiliation(s)
- Viola Voncken-Brewster
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mylène Amoureus
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Zsolt Nagykaldi
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma, OK, United States
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Huibert Tange
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
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Exploring beliefs about dietary supplement use: focus group discussions with Dutch adults. Public Health Nutr 2017; 20:2694-2705. [PMID: 28768564 DOI: 10.1017/s1368980017001707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Although dietary supplement use is increasing in Europe and the USA, little research involving adults' beliefs regarding dietary supplements has been conducted. Therefore, the present study aimed to explore and compare users' and non-users' beliefs towards dietary supplements. DESIGN Thirteen focus group discussions were conducted of which seven groups were dietary supplement users and six groups were non-users. Based on the socio-cognitive factors of the Integrated Change Model, a semi-structured topic guide was set up. The discussions were audio-recorded and subjected to qualitative content analysis, applying the framework approach. SETTING Data were collected in Maastricht, the Netherlands, in 2014 and 2015. SUBJECTS In total fifty-six individuals participated in the study, of whom twenty-eight were dietary supplement users and twenty-eight non-users. The average age of participants was 42·9 years. RESULTS Dietary supplement users' attitude beliefs were mainly related to mental and physical health enhancement, illness prevention and curative health benefits. Users were critical of the nutritional knowledge of health professionals and of the quality of food products. Non-users were convinced that the human body does not need any support and that regular food is enough to cover one's nutritional needs. Users and non-users held comparable beliefs regarding the definition and risks of dietary supplements, and perceived social influences. CONCLUSIONS In their decision about dietary supplement use, both groups were guided by their own convictions to a great extent. Both groups would benefit from improved understanding of the health effects of dietary supplements to improve informed decision making.
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Baron R, Martin L, Gitsels-van der Wal JT, Noordman J, Heymans MW, Spelten ER, Brug J, Hutton EK. Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses. Midwifery 2017; 54:7-17. [PMID: 28780476 DOI: 10.1016/j.midw.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. DESIGN quantitative video analyses. SETTING AND PARTICIPANTS 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. FINDINGS our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Linda Martin
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Evelien R Spelten
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public Health, Rural Health School, La Trobe University, Melbourne, VIC 3086, Australia
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
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Coons KD, Watson SL, Yantzi NM, Lightfoot NE, Larocque S. "No Alcohol Is Recommended, But . . .": Health Care Students' Attitudes About Alcohol Consumption During Pregnancy. Glob Qual Nurs Res 2017; 4:2333393617707663. [PMID: 28567436 PMCID: PMC5438105 DOI: 10.1177/2333393617707663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 12/02/2022] Open
Abstract
Canadian findings suggest that health care providers require further training and education to support their work preventing fetal alcohol spectrum disorder (FASD). However, the knowledge and training of health care students in relation to FASD remains largely unexplored. The purpose of this study was to understand the attitudes and beliefs of health care students about alcohol use during pregnancy. Twenty-one health care students participated in a scenario-based vignette about alcohol consumption during pregnancy. Although almost all students recognized that no alcohol consumption during pregnancy is the safest recommendation, many students recounted that this advice is not always conveyed during encounters with their pregnant patients. Three primary themes related to students’ attitudes concerning alcohol use during pregnancy were identified. Health care professionals in training need further education about the risks of alcohol consumption during pregnancy and the potential health outcomes associated with prenatal alcohol exposure.
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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 Obstet Gynecol Reprod Biol 2017; 213:45-52. [PMID: 28426943 DOI: 10.1016/j.ejogrb.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 12/14/2022]
Abstract
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support programmes to be targeted at those most in need. We aimed to conduct a systematic review to compare the efficacy of blood analysis and maternal self-report in detecting at risk women during pregnancy. This review investigated diagnostic accuracy. We searched four databases (Medline, Embase, Psychinfo and CINAHL) for relevant articles and conducted hand searches of recent issues of key journals in the field. No restriction was placed on inclusion in terms of publication date or language. Studies were deemed eligible if they were original research and included a direct comparison of the results of blood biomarker analysis and self-reported alcohol use for the detection of alcohol consumption in pregnant women. Quality appraisal of included studies was conducted using the QUADAS II tool. Eight studies met the inclusion criteria. Gamma-glutamyltransferase (GGT) was investigated in five studies, mean corpuscular volume (MCV) and phosphatidylethanol (PEth) in three studies and carbohydrate deficient transferrin (CDT), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and whole blood associated acetaldehyde assay (WBAA) were each investigated in two studies. Although all of the studies were rated of good methodological quality, none of the biomarkers had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. In summary, the blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such and CDT and PEth may complement self-report and help improve the accuracy of diagnosis.
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Affiliation(s)
- Helen Howlett
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.
| | - Sarah Abernethy
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Nigel W Brown
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
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Baron R, Heesterbeek Q, Manniën J, Hutton EK, Brug J, Westerman MJ. Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands. Midwifery 2017; 46:37-44. [PMID: 28161688 DOI: 10.1016/j.midw.2017.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. DESIGN qualitative semi-structured interview study, using thematic analysis and constant comparison. SETTING AND PARTICIPANTS twenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013. FINDINGS women considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE health education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Querine Heesterbeek
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Judith Manniën
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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van der Wulp NY, Hoving C, de Vries H. Correlates of partner support to abstain from prenatal alcohol use: a cross-sectional survey among Dutch partners of pregnant women. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:614-622. [PMID: 25944241 DOI: 10.1111/hsc.12235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 06/04/2023]
Abstract
Partners can play an important role, but are often ignored in interventions targeting the prevention of prenatal alcohol use. A better understanding of the correlates of partner support to abstain from prenatal alcohol use can help to make a better use of partner support. The aim of this study was to identify correlates of this support by analysing differences between partners reporting low versus high support. An online cross-sectional study among 237 Dutch partners of pregnant women was conducted. Respondents were recruited through Dutch midwifery practices in September-October 2009. Questionnaires were based on the I-Change Model. Chi-square and t-test showed that partners reporting high support were more likely to desire their partner to abstain from alcohol use and to have received advice from their pregnant spouse or midwife that abstinence was desirable. They also had stronger perceptions that the baby would experience harm from prenatal alcohol use and that harm could be more severe, and they saw more advantages and fewer disadvantages of providing support. They also reported more influence from their social environment encouraging their support, had greater self-efficacy and had a stronger intention to support their partner during the remainder of the pregnancy compared to partners reporting low support. Health professionals may improve their alcohol advice by discussing the advantages and disadvantages of support with the partner and by encouraging couples to discuss and propose solutions for the situations in which partners find it difficult not to support alcohol abstinence. By providing an insight into important correlates of partner support, this study expands the research area aiming to reduce prenatal alcohol use.
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Affiliation(s)
- Nickie Y van der Wulp
- Dutch Institute for Alcohol Policy (STAP), Utrecht, The Netherlands
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ciska Hoving
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Sympathy, shame, and few solutions: News media portrayals of fetal alcohol spectrum disorders. Midwifery 2016; 40:49-54. [DOI: 10.1016/j.midw.2016.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
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Development of a scale to evaluate midwives' beliefs about assessing alcohol use during pregnancy. BMC Pregnancy Childbirth 2015; 15:353. [PMID: 26715154 PMCID: PMC4696289 DOI: 10.1186/s12884-015-0779-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/07/2015] [Indexed: 01/04/2023] Open
Abstract
Background Prenatal alcohol exposure is an important modifiable cause of adverse fetal outcomes during and following pregnancy. Midwives are key providers of antenatal care, and it is important to understand the factors which influence their ability to provide appropriate advice and support to women about alcohol use in pregnancy. The main aim of this study was to develop a psychometrically valid scale to evaluate midwives’ beliefs about assessing alcohol use during pregnancy. Method A self-administered questionnaire was developed to evaluate midwives’ beliefs about assessing alcohol use during pregnancy, including beliefs about positive and negative consequences of asking about alcohol use, and beliefs about capacity to assess alcohol use. The questionnaire was sent to 245 midwives working for a state-wide country health service in Western Australia. Exploratory factor analysis was used to identify the latent constructs assessed by the 36 belief items and provide initial construct validation of the Asking About Alcohol (AAA) Scale. Results Of the 166 (67.8 %) midwives who responded to the survey, 160 (96.4 %) completed one or more of the belief items and were included in this analysis. Factor analysis identified six subscales which assessed beliefs about discomfort, capacity, effectiveness, role, trust and knowledge. Midwives held the most positive beliefs about their capacity to ask and the effectiveness of asking about alcohol use, and the least positive beliefs about women’s knowledge about alcohol use and discomfort associated with asking about alcohol use in pregnancy. Midwives’ beliefs about their role and the effectiveness of asking were most strongly associated with the intention to ask all pregnant women about alcohol use during pregnancy (r = −0.59, p < 0.001 and r = −0.52, p < 0.001). Conclusions Our analysis has identified key constructs underlying midwives’ beliefs about the assessment of alcohol use during pregnancy. The AAA Scale provides a basis for improved clarity and consistency in the conceptualisation and measurement of midwives’ beliefs which can be used to enhance our understanding of factors influencing midwives’ ability to deliver interventions to prevent alcohol use during pregnancy. The constructs identified in this exploratory analysis require confirmatory analysis to support their validity and generalizability. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0779-6) contains supplementary material, which is available to authorized users.
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van der Wulp NY, Hoving C, de Vries H. Partner's influences and other correlates of prenatal alcohol use. Matern Child Health J 2015; 19:908-16. [PMID: 25087003 DOI: 10.1007/s10995-014-1592-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the influence of partners on alcohol consumption in pregnant women within the context of other factors. A Dutch nationwide online cross-sectional study among 158 pregnant women and their partners was conducted. To identify correlates of prenatal alcohol use, including perceived and reported partner norm (i.e. partner's belief regarding acceptability of prenatal alcohol use), partner modeling (i.e. partner's alcohol use during the woman's pregnancy) and partner support (i.e. partner's help in abstaining from alcohol during pregnancy), independent sample T-tests and Chi square tests were conducted. Correlation analyses tested the relationship between perceived and reported partner influence. Multivariate logistic hierarchical regression analyses tested the independent impact of partner's perceived and reported influence next to other correlates from the I-Change Model. Pregnant women who consumed alcohol perceived a weaker partner norm (p < 0.001) and less partner modeling (p < 0.05), with the partner reporting a weaker norm (p < 0.001), more drinking days per week (p < 0.05) and weaker support (p < 0.05). Perceived and reported partner norm, modeling and support were positively related (respectively p < 0.01, p < 0.01 and p < 0.05). The multivariate analyses demonstrated that pregnant women with a higher education who perceived lower severity of harm due to prenatal alcohol use and a weaker partner norm were more likely to use alcohol (R(2) = 0.42). This study demonstrated that perceived partner norm was the most critical of the constructs of perceived and reported partner influences in explaining prenatal alcohol use.
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Affiliation(s)
- Nickie Y van der Wulp
- Dutch Institute for Alcohol Policy STAP, P.O. Box 9769, 3506 GT, Utrecht, The Netherlands,
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Reinwand DA, Crutzen R, Elfeddali I, Schneider F, Schulz DN, Smit ES, Stanczyk NE, Tange H, Voncken-Brewster V, Walthouwer MJL, Hoving C, de Vries H. Impact of Educational Level on Study Attrition and Evaluation of Web-Based Computer-Tailored Interventions: Results From Seven Randomized Controlled Trials. J Med Internet Res 2015; 17:e228. [PMID: 26446779 PMCID: PMC4642402 DOI: 10.2196/jmir.4941] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background Web-based computer-tailored interventions have shown to be effective in improving health behavior; however, high dropout attrition is a major issue in these interventions. Objective The aim of this study is to assess whether people with a lower educational level drop out from studies more frequently compared to people with a higher educational level and to what extent this depends on evaluation of these interventions. Methods Data from 7 randomized controlled trials of Web-based computer-tailored interventions were used to investigate dropout rates among participants with different educational levels. To be able to compare higher and lower educated participants, intervention evaluation was assessed by pooling data from these studies. Logistic regression analysis was used to assess whether intervention evaluation predicted dropout at follow-up measurements. Results In 3 studies, we found a higher study dropout attrition rate among participants with a lower educational level, whereas in 2 studies we found that middle educated participants had a higher dropout attrition rate compared to highly educated participants. In 4 studies, no such significant difference was found. Three of 7 studies showed that participants with a lower or middle educational level evaluated the interventions significantly better than highly educated participants (“Alcohol-Everything within the Limit”: F2,376=5.97, P=.003; “My Healthy Behavior”: F2,359=5.52, P=.004; “Master Your Breath”: F2,317=3.17, P=.04). One study found lower intervention evaluation by lower educated participants compared to participants with a middle educational level (“Weight in Balance”: F2,37=3.17, P=.05). Low evaluation of the interventions was not a significant predictor of dropout at a later follow-up measurement in any of the studies. Conclusions Dropout attrition rates were higher among participants with a lower or middle educational level compared with highly educated participants. Although lower educated participants evaluated the interventions better in approximately half of the studies, evaluation did not predict dropout attrition. Further research is needed to find other explanations for high dropout rates among lower educated participants.
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Affiliation(s)
- Dominique A Reinwand
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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Rushmer RK, Cheetham M, Cox L, Crosland A, Gray J, Hughes L, Hunter DJ, McCabe K, Seaman P, Tannahill C, Van Der Graaf P. Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BackgroundConsiderable resources are spent on research to establish what works to improve the nation’s health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not ‘fit’ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities.ObjectiveTo work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms.Design, setting and participantsTwo in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaser–provider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption.MethodsSixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (n = 23 andn = 15) and one national workshop (n = 10) were undertaken. A questionnaire (n = 73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings.FindingsNot all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base).ConclusionsTwo mid-range theories explain the findings. If evidence hassaliency(relates to ‘here and now’ as opposed to ‘there and then’) andimmediacy(short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) ‘blends’. Gaining this agreement across stakeholders appeared more difficult across the purchaser–provider split, because opportunities to interact were curtailed; however, more research is needed.FundingThis study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research.
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Affiliation(s)
- Rosemary K Rushmer
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Mandy Cheetham
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Lynda Cox
- Clinical Directorates, NHS England, Newcastle upon Tyne, UK
| | - Ann Crosland
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Joanne Gray
- Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - David J Hunter
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Wolfsan Research Institute, Durham University, Durham, UK
| | - Karen McCabe
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Pete Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Peter Van Der Graaf
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Wangberg SC. Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:186-90. [PMID: 26842644 DOI: 10.1016/j.srhc.2015.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/29/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed the current screening for and brief intervention (BI) on alcohol use in pregnancy among midwives in Norway, as well as perceived barriers for such practice. DESIGN, SETTING AND PARTICIPANTS An Internet and telephone survey was conducted among all 200 registered municipal midwives in the Norwegian health regions North, West and South in the period December 2013-May 2014. Of these, 103 midwives were reached and responded (52%). MEASUREMENT AND FINDINGS Most of the midwives (97%) asked the pregnant women about their alcohol use at their first consultation. 42% of the midwives reported using a screening instrument. When asked which one, AUDIT or TWEAK was mentioned by 16%. The need for more training in screening tools was reported by 66%. Sixty-four percent of midwives working in municipalities that had received special training compared with 50% among the rest said that they intervened themselves if alcohol use was detected (χ(2) = 0.32, P = .645). Motivational Interviewing was well known and frequently used. Low perceived BI competence and finding it difficult to discuss alcohol use with parents with a different ethnicity both reduced chances of carrying out a BI. Time constraints and lack of organizational support were other frequently mentioned barriers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE It seems that the Norwegian midwives find screening and brief interventions for alcohol use to be important and part of their job, but still could use more training, stronger guidelines and more time for following up parents.
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Affiliation(s)
- Silje C Wangberg
- Department of Health and Society, Narvik University College, P.O. Box 385, N-8020 Narvik, Norway; Regional Centre on Substance Use, University Hospital of North-Norway, Teknologiveien 10, N-8517 Narvik, Norway.
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van der Wulp NY, Hoving C, Eijmael K, Candel MJJM, van Dalen W, De Vries H. Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial. J Med Internet Res 2014; 16:e274. [PMID: 25486675 PMCID: PMC4275508 DOI: 10.2196/jmir.3493] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022] Open
Abstract
Background Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode. Objective The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol. Methods A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use. Results Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant. Conclusions This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person’s anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol. Trial Registration Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol)
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Meurk CS, Broom A, Adams J, Hall W, Lucke J. Factors influencing women's decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication. BMC Pregnancy Childbirth 2014; 14:246. [PMID: 25060554 PMCID: PMC4122767 DOI: 10.1186/1471-2393-14-246] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy. METHODS Semi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34-39, drawn from the Australian Longitudinal Study on Women's Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not. RESULTS Women generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption. CONCLUSIONS The significance of alcohol to women's identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a "healthy" choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered.
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Affiliation(s)
- Carla S Meurk
- />Postdoctoral Research Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, Queensland 4029 Australia
| | - Alex Broom
- />Sociology, Australian Research Council Future Fellow, The University of Queensland, School of Social Science, St Lucia, Queensland 4072 Australia
| | - Jon Adams
- />Public Health, National Health and Medical Research Council Career Development Fellow, University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, NSW 2007 Australia
| | - Wayne Hall
- />Australia Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, 4029 Queensland
| | - Jayne Lucke
- />Principal Research Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, 4029 Queensland
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Feltes BC, de Faria Poloni J, Nunes IJG, Bonatto D. Fetal alcohol syndrome, chemo-biology and OMICS: ethanol effects on vitamin metabolism during neurodevelopment as measured by systems biology analysis. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2014; 18:344-63. [PMID: 24816220 DOI: 10.1089/omi.2013.0144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fetal alcohol syndrome (FAS) is a prenatal disease characterized by fetal morphological and neurological abnormalities originating from exposure to alcohol. Although FAS is a well-described pathology, the molecular mechanisms underlying its progression are virtually unknown. Moreover, alcohol abuse can affect vitamin metabolism and absorption, although how alcohol impairs such biochemical pathways remains to be elucidated. We employed a variety of systems chemo-biology tools to understand the interplay between ethanol metabolism and vitamins during mouse neurodevelopment. For this purpose, we designed interactomes and employed transcriptomic data analysis approaches to study the neural tissue of Mus musculus exposed to ethanol prenatally and postnatally, simulating conditions that could lead to FAS development at different life stages. Our results showed that FAS can promote early changes in neurotransmitter release and glutamate equilibrium, as well as an abnormal calcium influx that can lead to neuroinflammation and impaired neurodifferentiation, both extensively connected with vitamin action and metabolism. Genes related to retinoic acid, niacin, vitamin D, and folate metabolism were underexpressed during neurodevelopment and appear to contribute to neuroinflammation progression and impaired synapsis. Our results also indicate that genes coding for tubulin, tubulin-associated proteins, synapse plasticity proteins, and proteins related to neurodifferentiation are extensively affected by ethanol exposure. Finally, we developed a molecular model of how ethanol can affect vitamin metabolism and impair neurodevelopment.
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Affiliation(s)
- Bruno César Feltes
- Centro de Biotecnologia da Universidade Federal do Rio Grande do Sul , Departamento de Biologia Molecular e Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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