Development of a scale to evaluate midwives’ beliefs about assessing alcohol use during pregnancy

Abstract

BackgroundPrenatal 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.MethodA 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.ResultsOf 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).ConclusionsOur 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 materialThe online version of this article (doi:10.1186/s12884-015-0779-6) contains supplementary material, which is available to authorized users.

Barriers to the implementation of clinical guidelines for maternal alcohol consumption in antenatal services: A survey using the theoretical domains framework

“…Despite this, previous studies assessing barriers to the adherence of maternal alcohol guideline recommendations have not utilised comprehensive implementation frameworks, and subsequently have focussed on a narrow range of potential barriers that are clinician focused . Nonetheless, the following barriers to the provision of clinical guideline recommendations for maternal alcohol consumption have been reported in the literature: a lack of knowledge or confidence in assessing and advising pregnant women about alcohol consumption; a belief that addressing alcohol will cause discomfort or impact on the client‐clinician relationship; and a lack of training, time or resources . Other factors suggested by implementation frameworks to potentially impede the implementation of clinical guidelines in general, such as a lack of planning in how to deliver the guidelines in consults and a lack of feedback to help improve care provision, have not been assessed.…”

Prenatal Alcohol Screening During Pregnancy by Midwives and Nurses

“…There have been few studies of what providers know about the effects of prenatal alcohol. Watkins and colleagues () surveyed midwives in Western Australia about assessing alcohol use during pregnancy, including positive and negative consequences of asking and their capacity to assess drinking (Watkins et al., ). They reported that midwives were most positive about their capacity to ask and the effectiveness of asking, and least positive about patients’ knowledge about the effects of alcohol use and their own comfort in asking.…”

“…They reported that midwives were most positive about their capacity to ask and the effectiveness of asking, and least positive about patients’ knowledge about the effects of alcohol use and their own comfort in asking. Watkins and colleagues () did not assess screening practices, but a prerequisite for screening is an awareness of the potentially damaging effects of alcohol during pregnancy (Floyd et al., ; Goodman and Wolff, ) and belief that screening is effective and acceptable to patients. Yet providers often reported feeling unprepared to educate their pregnant patients about the risks of prenatal alcohol because they themselves do not fully understand the effects.…”

Screening Women for At‐Risk Alcohol Use: An Introduction to Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Women's Health

“…Fears may include potential charges of child abuse, as is the case under civil child welfare statutes in 18 states, or civil commitment in 3 states . Clinicians may struggle to balance the need to address alcohol use in pregnancy with their fear that this discussion could create distrust among the women in their care …”

“…24 Clinicians may struggle to balance the need to address alcohol use in pregnancy with their fear that this discussion could create distrust among the women in their care. 25 Four tools clinicians should consider for use in prenatal care settings include the 1) AUDIT-C; 2) Tolerance, Annoyed, Cut-Down, Eye-Opener (T-ACE) test; 3) Tolerance, Worried, Eye-opener, Amnesia, and Cut-Down (TWEAK) test; and 4) One-Question Prenatal Alcohol Use Assessment ( Table 1).…”