A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial

被引：28

作者：

Kingsland, Melanie ^{[1
,2
,3
]}

Doherty, Emma ^{[1
,2
,3
]}

Anderson, Amy E. ^{[2
,3
]}

Crooks, Kristy ^{[1
,4
]}

Tully, Belinda ^{[1
]}

Tremain, Danika ^{[1
,2
,3
]}

Tsang, Tracey W. ^{[5
,6
]}

Attia, John ^{[2
,3
]}

Wolfenden, Luke ^{[1
,2
,3
]}

Dunlop, Adrian J. ^{[2
,3
,7
]}

Bennett, Nicole ^{[8
]}

Hunter, Mandy ^{[8
]}

Ward, Sarah ^{[9
]}

Reeves, Penny ^{[2
,3
]}

Symonds, Ian ^{[10
]}

Rissel, Chris ^{[5
,11
]}

Azzopardi, Carol ^{[8
]}

Searles, Andrew ^{[2
,3
]}

Gillham, Karen ^{[1
]}

Elliott, Elizabeth J. ^{[5
,6
]}

Wiggers, John ^{[1
,2
,3
]}

机构：

[1] Hunter New England Local Hlth Dist, Hunter New England Populat Hlth, Wallsend, NSW, Australia

[2] Univ Newcastle, Sch Med & Publ Hlth, Callaghan, NSW, Australia

[3] Hunter Med Res Inst, New Lambton Hts, NSW, Australia

[4] Charles Darwin Univ, Menzies Sch Hlth Res, Darwin, NT, Australia

[5] Univ Sydney, Sch Med, Camperdown, NSW, Australia

[6] Sydney Childrens Hosp Network, Kids Res Inst, Westmead, NSW, Australia

[7] Hunter New England Local Hlth Dist, Drug & Alcohol Clin Serv, Newcastle, NSW, Australia

[8] Matern & Gynaecol John Hunter Hosp, New Lambton Hts, NSW, Australia

[9] Fdn Alcohol Res & Educ, Deakin, ACT, Australia

[10] Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia

[11] New South Wales Off Prevent Hlth, Liverpool, Merseyside, Australia

来源：

IMPLEMENTATION SCIENCE | 2018年 / 13卷

基金：

澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;

关键词：

Maternal; Alcohol consumption; Pregnancy; Antenatal care; Implementation; Clinical practice change; Stepped-wedge trial; Protocol; PEDIATRICIANS KNOWLEDGE; HEALTH-PROFESSIONALS; AUSTRALIAN WOMEN; BEHAVIOR-CHANGE; FETAL; IMPLEMENTATION; ATTITUDES; PREVENTION; EXPOSURE; MIDWIVES;

D O I：

10.1186/s13012-018-0806-x

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women. Methods: The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at 'booking in', 27-28 weeks gestation and 35-36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome. Discussion: This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child.

引用

页数：14

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