一项关于改变孕妇饮酒行为的产前项目的现实主义评价。
A realist evaluation of an antenatal programme to change drinking behaviour of pregnant women.
作者信息
Doi Lawrence, Jepson Ruth, Cheyne Helen
机构信息
20 West Richmond Street, Scottish Collaboration for Public Health Research and Policy, Centre for Population Health Sciences, University of Edinburgh, EH8 9DX Scotland, UK.
Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, UK.
出版信息
Midwifery. 2015 Oct;31(10):965-72. doi: 10.1016/j.midw.2015.06.007. Epub 2015 Jun 16.
OBJECTIVE
to use realist evaluation to describe and explain how and in what circumstances screening and alcohol brief interventions work in routine antenatal care.
DESIGN
a realist evaluation incorporating systematic reviews and qualitative data.
SETTING
NHS Lothian, which is one of the 14 Scottish health boards.
PARTICIPANTS
participants were recruited from two maternity units. In phase one, interviews were conducted with four participants responsible for policy implementation. These data were supported by two systematic reviews. In phase two, 17 pregnant women and 15 midwives participated in interviews, with a further six midwifery team leaders involved in a focus group.
FINDINGS
training and resources provided to midwives as part of the programme acted as facilitating mechanisms that improved their skills and confidence to screen and deliver alcohol brief interventions. The programme elicited positive change in attitudes to drinking in pregnancy and possibly stimulated drinking behaviour change amongst pregnant women. However, the small numbers of pregnant women being identified for alcohol brief interventions meant delivery was infrequent and resulted in the programme not working as anticipated. The findings also revealed contextual issues around midwife-pregnant woman relationship and the challenges of negotiating the timing of screening and alcohol brief interventions delivery.
CONCLUSIONS
Drinking in pregnancy is an emotive issue, therefore delivering alcohol brief interventions at the first antenatal appointment when they are more likely to achieve the most benefits poses challenges. When training midwives to screen and deliver alcohol brief interventions, special attention is needed to improve person-centred communication skills to overcome barriers associated with discussing sensitive prenatal alcohol use and enhance early identification and delivery of alcohol brief interventions at the first antenatal appointment.
目的
运用现实主义评价法来描述和解释在常规产前护理中筛查及酒精简短干预如何发挥作用以及在何种情况下发挥作用。
设计
一项纳入系统评价和定性数据的现实主义评价。
背景
NHS洛锡安，苏格兰14个卫生委员会之一。
参与者
参与者从两个产科病房招募。在第一阶段，对四名负责政策实施的人员进行了访谈。这些数据得到两项系统评价的支持。在第二阶段，17名孕妇和15名助产士参与了访谈，另有6名助产团队负责人参与了焦点小组。
研究结果
作为该项目一部分向助产士提供的培训和资源起到了促进机制的作用，提高了她们进行筛查及提供酒精简短干预的技能和信心。该项目使对孕期饮酒的态度产生了积极变化，并可能促使孕妇的饮酒行为发生改变。然而，被确定接受酒精简短干预的孕妇数量较少，这意味着干预实施频率不高，导致该项目未能按预期发挥作用。研究结果还揭示了助产士与孕妇关系方面的背景问题以及协商筛查和酒精简短干预实施时间的挑战。
结论
孕期饮酒是一个情绪化的问题，因此在首次产前检查时进行酒精简短干预，而此时干预更有可能带来最大益处，这带来了挑战。在培训助产士进行筛查及提供酒精简短干预时，需要特别关注提高以患者为中心的沟通技巧，以克服与讨论敏感的产前酒精使用相关的障碍，并加强在首次产前检查时对酒精简短干预的早期识别和实施。
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