Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial

Emma Doherty; Melanie Kingsland; Elizabeth J Elliott; Belinda Tully; Luke Wolfenden; Adrian Dunlop; Ian Symonds; John Attia; Sarah Ward; Mandy Hunter; Carol Azzopardi; Chris Rissel; Karen Gillham; Tracey W Tsang; Penny Reeves; John Wiggers

doi:10.1186/s12884-022-04646-7

Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial

BMC Pregnancy Childbirth. 2022 Apr 21;22(1):345. doi: 10.1186/s12884-022-04646-7.

Authors

Emma Doherty^{1

2

3}, Melanie Kingsland^{4

5

6}, Elizabeth J Elliott^{7

8}, Belinda Tully⁴, Luke Wolfenden^{4

5

6}, Adrian Dunlop^{5

6

9}, Ian Symonds¹⁰, John Attia^{5

6}, Sarah Ward¹¹, Mandy Hunter¹², Carol Azzopardi¹², Chris Rissel¹³, Karen Gillham⁴, Tracey W Tsang^{7

8}, Penny Reeves⁶, John Wiggers^{4

5

6}

Affiliations

¹ Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia. emma.doherty@health.nsw.gov.au.
² School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. emma.doherty@health.nsw.gov.au.
³ Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia. emma.doherty@health.nsw.gov.au.
⁴ Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.
⁵ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
⁶ Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
⁷ Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.
⁸ Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia.
⁹ Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, 2302, Australia.
¹⁰ Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
¹¹ Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, 2600, Australia.
¹² Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia.
¹³ College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory, 0909, Australia.

Abstract

Background: Clinical guideline recommendations for addressing alcohol consumption during pregnancy are sub-optimally implemented and limited evidence exists to inform practice improvements. The aim of this study was to estimate the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services.

Methods: A randomised stepped-wedge controlled trial was undertaken with all public maternity services in three sectors (one urban, two regional/rural) of a single local health district in New South Wales, Australia. All antenatal care providers were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care. For 35 months (July 2017 - May 2020) outcome data were collected from randomly selected women post an initial, 27-28 weeks and 35-36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness.

Results: Five thousand six hundred ninety-four interviews/online questionnaires were completed by pregnant women. The intervention was effective in increasing women's reported receipt of: assessment of alcohol consumption (OR: 2.63; 95% CI: 2.26-3.05; p < 0.001), advice not to consume alcohol during pregnancy and of potential risks (OR: 2.07; 95% CI: 1.78-2.41; p < 0.001), complete care relevant to alcohol risk level (advice and referral) (OR: 2.10; 95% CI: 1.80-2.44; p < 0.001) and all guideline elements relevant to alcohol risk level (assessment, advice and referral) (OR: 2.32; 95% CI: 1.94-2.76; p < 0.001). Greater intervention effects were found at the 27-28 and 35-36 weeks gestation visits compared with the initial antenatal visit. No differences by sector were found. Almost all women (98.8%) reported that the model of care was acceptable.

Conclusions: The practice change intervention improved the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Future research could explore the characteristics of pregnant women and maternity services associated with intervention effectiveness as well as the sustainment of care practices over time to inform the need for, and development of, further tailored practice change support.

Trial registration: Australian and New Zealand Clinical Trials Registry (Registration number: ACTRN12617000882325; Registration date: 16/06/2017) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372985&isReview=true.

Keywords: Alcohol; Antenatal care; Clinical practice change; Implementation; Outcomes; Pregnancy; Stepped-wedge trial.

Publication types

Randomized Controlled Trial

MeSH terms

Alcohol Drinking / prevention & control
Australia
Female
Humans
Pregnancy
Pregnant Women*
Prenatal Care*
Rural Population