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

Abstract

Background: There is a significant gap in the knowledge translation literature related to how research evidence actually contributes to health care decision-making. Decisions around what care to provide at the population (rather than individual) level are particularly complex, involving considerations such as feasibility, cost, and population needs in addition to scientific evidence. One example of decision-making at this "population-policy" level involves what screening questions and intervention guides to include on standardized provincial prenatal records. As mandatory medical reporting forms, prenatal records are potentially powerful vehicles for promoting population-wide evidence-based care. However, the extent to which Canadian prenatal records reflect best-practice recommendations for the assessment of well-known risk factors such as maternal smoking and alcohol consumption varies markedly across Canadian provinces and territories. The goal of this study is to better understand the interaction of contextual factors and research evidence on decision-making at the population-policy level, by examining the processes by which provincial prenatal records are reviewed and revised.

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

“…Clinicians face pragmatic realities when they try to include environmental health assessment and counselling in routine clinical practice. Numerous studies in the field of tobacco control have addressed some of these challenges such as those examining brief motivational counselling [ 61 ] or the inclusion of tobacco assessment criteria in standard prenatal records [ 62 , 63 ]. Similar efforts are needed in relation to other environmental hazards.…”

Do Canadian Prenatal Record Forms Integrate Evidence-based Guidelines for the Diagnosis of a FASD?

“…Research currently underway has revealed that the participants and processes involved in the revision of prenatal record forms vary considerably across Canadian jurisdictions, and the inclusion (or not) of specific prenatal screening questions may be influenced by such diverse factors as feasibility, cost or population needs. 31 More information about contextual factors such as provincial rates of maternal risk drinking and FASD, marketing of alcohol, and the presence or influence of provincial FASD committees is needed to better understand the uptake of research evidence related to screening and interventions for maternal alcohol consumption into provincial/territorial prenatal record forms.…”

Who Is Telling Pregnant Women About Listeriosis?

“…11 To facilitate the transfer of important pregnancy information between members of the circle of care as well as between different health care facilities, Canadian provinces and territories have developed prenatal records. 12 These records help standardize the information both obtained from and delivered to pregnant women and are novel because they illuminate some of the information that is communicated to this vulnerable population. In Canada, each province and territory has its own prenatal record with the exception of the Yukon, which uses the same record as British Columbia.…”

“…In Canada, each province and territory has its own prenatal record with the exception of the Yukon, which uses the same record as British Columbia. 12 A copy of each of these prenatal records was obtained from government websites, the College of Physicians and Surgeons for that province/territory, or by directly contacting a practicing obstetrician/gynecologist in that province/territory. An excerpt from Alberta's Prenatal Record is shown in Figure 1.…”