Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

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.

Midwives’ views on alcohol guidelines: A qualitative study of barriers and facilitators to implementation in UK antenatal care

“…We have previously reported on the range of approaches from midwives advising alcohol abstinence to pregnant women [17], as have other UK-based studies [22,23]. The lack of uniform ways of addressing alcohol leads to difficulties in fully understanding the scale of the problem of alcohol use during pregnancy in the UK, as well as how to best address it.…”

“…This qualitative study was part of a larger mixed-methods study of implementation of the Guidelines in antenatal care [16]. The first phase of the research was a nation-wide survey, which we report on elsewhere [17] and informed the second phase reported on here. The findings from the survey were used to devise the interview topic guide and indicated areas to explore in-depth.…”

“…In the phase preceding the current study [17], our survey showed that 58% of midwives were aware of the Guidelines and we asked participants in the current study to reflect on that statistic.…”

Supportive alcohol policy as a key element of fetal alcohol spectrum disorder prevention

“…Furthermore, while almost all midwives advised women to abstain from alcohol during their initial appointment, the implementation of this advice dropped to 38% at subsequent visits. 30 …”

Virtual recruitment and participant engagement for substance use research during a pandemic

“…Paid advertisements through social media platforms were also successfully utilized in a study investigating substance use among Canadian youths [41]. Recruitment via social media also contributed to enrolling 842 midwives in the United Kingdom to identify determinants and variations in the implementation of guidelines related to alcohol use during pregnancy [42]. The feasibility and acceptability of social media recruitment have also been documented among racial/ethnic minority community members [34,47,48 ▪▪ ].…”