Comparing Prenatal Providers' Approaches to Four Different Risks: Alcohol, Tobacco, Drugs, and Domestic Violence

Herzig, Karen; Huynh, Dung T.; Gilbert, Paul A.; Danley, Dale; Jackson, Rebecca; Gerbert, Barbara

doi:10.1300/j013v43n03_05

Cited by 39 publications

(32 citation statements)

References 33 publications

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“…113,133,[162][163][164][165][166][167][168] The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers to or facilitators of an individual's ability to provide smoking cessation support to pregnant or postpartum women. Underpinning these factors was an acknowledgement that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation.…”

Section: Resultsmentioning

confidence: 99%

“…There was also recognition in the review studies and interviews that HPs could take a more assertive position, drawing attention to the negative effects of smoking on the baby in pregnancy and regarding the risks of SHS after birth. 133,[162][163][164][165] The systematic review of HPs found that professionals recognised the importance of involving women's partners in smoking cessation advice but this type of engagement was described as difficult -perhaps more difficult in the review studies than in the experiences of partners and SOs interviewed for this study.…”

Section: Barriers From Partners and Significant Othersmentioning

confidence: 93%

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Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

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Background: Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). Objectives: To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design: Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/ improved interventions for future testing. Setting: Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants: Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures: The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results: Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural s...

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Section: Resultsmentioning

confidence: 99%

Section: Barriers From Partners and Significant Othersmentioning

confidence: 93%

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Bauld

Graham

Sinclair

et al. 2017

Health Technol Assess

111

View full text Add to dashboard Cite

show abstract

“…In a qualitative study of prenatal care providers’ approaches to psychosocial risk factors, obstetricians felt “ill equipped” to manage issues related to domestic violence and other forms of abuse and “needed additional advice, tips and resources” to manage these patients. [18] In contrast, family medicine providers have a wider breadth of clinical training and may feel more equipped to handle a variety of psychosocial issues. In addition, almost 70% of obstetricians surveyed reported that less than 25% of their patients had at least one of the listed psychosocial risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…[15–17] This lack of intensive, risk-appropriate prenatal care services for many women with high psychosocial risk pregnancies may be due to provider level factors such as an underestimation of the prevalence of psychosocial risk factors, inadequate training, time constraints and a belief by providers that many interventions are ineffective. [18] Variation in approach towards psychosocial risk factors such as alcohol, tobacco and substance abuse during pregnancy has also been demonstrated among different types of prenatal care providers. [18]…”

Section: Introductionmentioning

confidence: 99%

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Impact of Psychosocial Risk Factors on Prenatal Care Delivery: A National Provider Survey

Moloci

Housey

Davis

2014

Matern Child Health J

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Objective To evaluate providers’ perspectives regarding the delivery of prenatal care to women with psychosocial risk factors. Methods A random, national sample of 2095 prenatal care providers (853 obstetricians and gynecologists (Ob/Gyns), 270 family medicine (FM) physicians and 972 midwives) completed a mailed survey. We measured respondents’ practice and referral patterns regarding six psychosocial risk factors: adolescence (age ≤ 19), unstable housing, lack of paternal involvement and social support, late prenatal care (> 13 weeks gestation), domestic violence and drug or alcohol use. Chi-square and logistic regression analyses assessed the association between prenatal care provider characteristics and prenatal care utilization patterns. Results Approximately 60% of Ob/Gyns, 48.4% of midwives and 32.2% of FM physicians referred patients with psychosocial risk factors to clinicians outside of their practice. In all three specialties, providers were more likely to increase prenatal care visits with alternative clinicians (social workers, nurses, psychologists/psychiatrists) compared to themselves for all six psychosocial risk factors. Drug or alcohol use and intimate partner violence were the risk factors that most often prompted an increase in utilization. In multivariate analyses, Ob/Gyns who recently completed clinical training were significantly more likely to increase prenatal care utilization with either themselves (OR=2.15; 95% CI 1.14–4.05) or an alternative clinician (2.27; 1.00–4.67) for women with high psychosocial risk pregnancies. Conclusions Prenatal care providers frequently involve alternative clinicians such as social workers, nurses and psychologists or psychiatrists in the delivery of prenatal care to women with psychosocial risk factors.

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Physician Reluctance to Intervene in Addiction

Campopiano von Klimo,

Nolan,

Corbin

et al. 2024

JAMA Netw Open

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ImportanceThe overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.ObjectiveTo describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.Data SourcesA literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.Study SelectionPublications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.Data Extraction and SynthesisTwo reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.Main Outcomes and MeasuresThe primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.ResultsA total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.Conclusions and RelevanceIn this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

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Comparing Prenatal Providers' Approaches to Four Different Risks: Alcohol, Tobacco, Drugs, and Domestic Violence

Abstract: A comparison of each risk across the Five A's illuminates the gaps between recommended and actual prevention methods and suggests directions for development of interventions and educational efforts.

Cited by 39 publications

References 33 publications

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

Impact of Psychosocial Risk Factors on Prenatal Care Delivery: A National Provider Survey

Physician Reluctance to Intervene in Addiction

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