Provincial prenatal record revision: a multiple case study of evidence-based decision-making at the population-policy level

A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health

Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.

Who is telling pregnant women about listeriosis?

During pregnancy, a woman's immune system is compromised and she is at an increased risk of infection and illness. In particular, the risk of contracting foodborne listeriosis is 20 times greater for pregnant women than for other women of reproductive age. Considering the negative effects of listeriosis on the developing fetus and that more than 380,000 babies were born in Canada in 2010, listeriosis is an important public health concern. And yet, in Canada, it is not clear who is responsible for educating pregnant women on the importance of safe food handling and the avoidance of high-risk foods. Not all women attend prenatal education classes and the circle of care during pregnancy is highly variable. Physicians, however, are very often included in the care circle and may represent a consistent, reliable and trustworthy source of food safety information. At present, only one province has prenatal records that prompt physicians to counsel pregnant women on food safety issues, though all include some assessment of nutrition, diet or supplement use. Improving provincial and territorial prenatal records may be one important way of helping to ensure that critical food safety information is reaching pregnant Canadians.

Do Canadian prenatal record forms integrate evidence-based guidelines for the diagnosis of a FASD?

OBJECTIVES

Prenatal alcohol exposure is a significant public health issue with lifelong psychological, emotional and financial costs associated with caring for an affected individual. In 2005, the Public Health Agency of Canada and Health Canada's First Nations and Inuit Health Branch developed evidence-based guidelines for the diagnosis of a Fetal Alcohol Spectrum Disorder (FASD). We examined the extent to which prenatal records across Canadian provinces and territories currently integrate key recommendations from these guidelines.

METHODS

A content analysis of prenatal record forms retrieved from each Canadian province and territory (N = 12) was conducted to identify all questions or intervention prompts related to prenatal screening, exposure assessment, counseling or referral for maternal alcohol use during pregnancy. Findings were reviewed in relation to recommendations extrapolated from the Canadian guidelines and the FASD literature.

RESULTS

All the prenatal record forms contained questions to assess maternal alcohol use during pregnancy. However, the dimensions of alcohol consumption assessed and the format, wording and number of items related to each dimension varied markedly across provinces/territories. Only five prenatal record forms included a validated screening tool to identify risky alcohol drinking behaviour. Most of the forms lacked prompts to encourage providers to intervene or refer pregnant clients with high-risk drinking behaviour.

CONCLUSION

Integration of the Canadian recommendations into Canadian prenatal record forms may be an effective public health strategy for helping identify pregnancies at high risk for alcohol exposure, reducing the incidence of a FASD through appropriate prenatal intervention and referral, and facilitating early diagnosis of a FASD.

Do Canadian prenatal record forms integrate evidence-based guidelines for the diagnosis of a FASD?

OBJECTIVES

Prenatal alcohol exposure is a significant public health issue with lifelong psychological, emotional and financial costs associated with caring for an affected individual. In 2005, the Public Health Agency of Canada and Health Canada's First Nations and Inuit Health Branch developed evidence-based guidelines for the diagnosis of a Fetal Alcohol Spectrum Disorder (FASD). We examined the extent to which prenatal records across Canadian provinces and territories currently integrate key recommendations from these guidelines.

METHODS

A content analysis of prenatal record forms retrieved from each Canadian province and territory (N = 12) was conducted to identify all questions or intervention prompts related to prenatal screening, exposure assessment, counseling or referral for maternal alcohol use during pregnancy. Findings were reviewed in relation to recommendations extrapolated from the Canadian guidelines and the FASD literature.

RESULTS

All the prenatal record forms contained questions to assess maternal alcohol use during pregnancy. However, the dimensions of alcohol consumption assessed and the format, wording and number of items related to each dimension varied markedly across provinces/territories. Only five prenatal record forms included a validated screening tool to identify risky alcohol drinking behaviour. Most of the forms lacked prompts to encourage providers to intervene or refer pregnant clients with high-risk drinking behaviour.

CONCLUSION

Integration of the Canadian recommendations into Canadian prenatal record forms may be an effective public health strategy for helping identify pregnancies at high risk for alcohol exposure, reducing the incidence of a FASD through appropriate prenatal intervention and referral, and facilitating early diagnosis of a FASD.