Abstract
Objective
To determine health care providers’ familiarity with and use of the Society of Obstetricians
and Gynaecologists of Canada's (SOGC's) 2010 Alcohol Use and Pregnancy Consensus Clinical Guidelines and to identify barriers and enablers that affected guideline uptake.
Methods
We conducted an online pan-Canadian survey of midwives, obstetricians, family physicians,
and nurses. The survey was divided into five sections: knowledge, SOGC guidelines,
screening and intervention practices, attitudes and beliefs, and demographic information.
Results
Just over half of the 588 respondents who provided care to pregnant women or to women
of childbearing age were familiar with and used the guidelines. Most respondents screened
for alcohol use by asking women about alcohol consumption, but relatively few used
a screening questionnaire. Approximately two-thirds of respondents provided brief
intervention and referral to harm reduction or treatment services. Enablers of guideline
adherence included knowledge about the risks of alcohol in pregnancy, perceived responsibility
to identify and address at-risk drinking, and a belief that women are motivated to
reduce their alcohol consumption if pregnant or planning to become pregnant. Lack
of confidence in ability to use screening questionnaires and to provide brief intervention,
as well as a lack of belief in the effectiveness of both practices, were barriers
to use.
Conclusion
Strategies are needed to improve familiarity with and uptake of the Alcohol Use and Pregnancy Consensus Clinical Guidelines. Particular attention should be given to education and training regarding the use
of validated screening questionnaires and brief intervention practices.
Résumé
Objectif
Déterminer le niveau de connaissance et d'utilisation chez les fournisseurs de soins
de santé relativement à la Directive clinique de consensus sur la consommation d'alcool et la grossesse que la Société des obstétriciens et gynécologues du Canada (SOGC) a publiée en 2010
et déterminer les obstacles et les facilitateurs qui ont influencé l'adoption de la
directive clinique.
Méthodologie
Nous avons réalisé un sondage pancanadien en ligne auprès de sages-femmes, d'obstétriciens,
de médecins de famille et d'infirmières. Le sondage a été divisé en cinq sections :
connaissances; directives cliniques de la SOGC; pratiques en matière de dépistage
et d'intervention; attitudes et croyances; et données démographiques.
Résultats
Un peu plus de la moitié des 588 répondants qui ont fourni des soins aux femmes enceintes
ou aux femmes en âge de procréer connaissaient bien les directives et les utilisaient.
La plupart des répondants effectuaient le dépistage en interrogeant les femmes sur
leur consommation d'alcool, mais très peu ont utilisé un questionnaire de dépistage.
Environ deux tiers des répondants ont fourni une intervention de courte durée et ont
orienté les patientes vers des services de traitement ou de réduction des dommages.
Les facilitateurs de l'application de la directive clinique comprenaient la connaissance
des risques liés à la consommation d'alcool pendant la grossesse, la responsabilité
perçue relativement à la détection et la rectification d'une consommation problématique
d'alcool, et la croyance voulant que les femmes soient motivées à réduire leur consommation
d'alcool si elles sont enceintes ou prévoient le devenir. Les obstacles à l'utilisation
de la directive étaient le manque de confiance des répondants dans leur capacité à
utiliser les questionnaires de dépistage et à fournir une intervention de courte durée,
ainsi qu'un manque de confiance en l'efficacité de ces deux pratiques.
Conclusion
De nouvelles stratégies seront nécessaires pour améliorer la connaissance et l'utilisation
de la Directive clinique de consensus sur la consommation d'alcool et la grossesse. Il y a lieu d'accorder une attention particulière à l’éducation et à la formation
relativement à l'utilisation de questionnaires de dépistage validés et aux pratiques
d'intervention de courte durée.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Alcohol use disorders in pregnancy.Harv Rev Psychiatry. 2015; 23: 112-121
- Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan.CMAJ. 2016; 188: 191-197
Public Health Agency of Canada. About fetal alcohol spectrum disorder (FASD). Available at: https://www.canada.ca/en/public-health/services/diseases/fetal-alcohol-spectrum-disorder/about.html. Accessed November 17, 2018.
- Prevalence of alcohol consumption during pregnancy and fetal alcohol spectrum disorders among the general and Aboriginal populations in Canada and the United States.Eur J Med Genet. 2017; 60: 32-48
- What mothers say: the Canadian Maternity Experiences Survey.2009 (Available at:) (Accessed November 17, 2018)
- Fetal alcohol spectrum disorder. Knowledge and attitudes of health professionals about fetal alcohol syndrome: results from a national survey.2005 (Available at:) (Accessed November 17, 2018)
- Alcohol use and pregnancy consensus clinical guidelines.J Obstet Gynaecol Can. 2010; 32: S1-S31
- Validation of the theoretical domains framework for use in behaviour change and implementation research.Implement Sci. 2012; 7: 37
- Barriers and strategies in guideline implementation.Healthcare. 2016; 4: 36
- A new model of adoption of clinical practice guidelines.J Public Health Manag Pract. 2007; 13: 605-611
- Getting the word out: new approaches for disseminating public health science.J Public Health Manag Pract. 2018; 24: 102-111
- Screening for alcohol and drug use disorders among adults in primary care: a review.Subst Abuse Rehabil. 2012; 3: 25-34
- Alcohol alert. Number 66.2005 (Rockville, MD. Available at:) (Accessed November 17, 2018)
- The role of screening, brief intervention, and referral to treatment in the perinatal period.Am J Obstet Gynecol. 2016; 215: 539-547
- Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice.Addiction. 2017; 112: 110-117
- Interventions delivered during antenatal care to reduce alcohol consumption during pregnancy: a systematic review.Addict Res Theory. 2011; 19: 235-250
- Preconceptual motivational interviewing to reduce alcohol-exposed pregnancy risk.J Subst Abuse Treat. 2013; 44: 407-416
- Improving screening for alcohol use during pregnancy: the Massachusetts ASAP program.Matern Child Health J. 2004; 8: 137-147
- Identifying hazardous alcohol consumption during pregnancy: implementing a research-based model in real life.Acta Obstet Gynecol Scand. 2006; 85: 657-662
Centers for Disease Control and Prevention C. CHOICES as a program to prevent alcohol-exposed pregnancies. Available at: https://www.cdc.gov/ncbddd/fasd/choices-program-prevent-alcohol-exposed-pregnancies.html. Accessed November 17, 2018.
- Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review.J Psychoactive Drugs. 2012; 44: 307-317
- Despite 2009 guidelines few women report being counseled correctly about weight gain during pregnancy.Am J Obstet Gynecol. 2011; 205: 333.e1-333.e6
- Little congruence between health care provider and patient perceptions of counselling on gestational weight gain.J Obstet Gynaecol Can. 2012; 34: 518-524
Article info
Publication history
Published online: July 19, 2020
Footnotes
Disclosures: This research was supported by a Public Health Agency of Canada contribution agreement.
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc.
