[Barriers to Addressing Pregnant Patients' Cigarette and Alcohol Use: A Focus Group Study with Gynecologists].

Alcohol drinking and tobacco smoking pose high health risks for the unborn child. Even though routine testing during the course of pregnancy facilitates early intervention, addressing substance use in pregnancy seems to be more difficult. The aim of the study was to identify barriers to addressing pregnant patients' cigarette and alcohol use. 2 focus groups (in total N=10 participants) were conducted with gynaecologists. The transcripts of the discussions were analysed using Mayring's approach of qualitative text analysis. Avoidance of addressing substance abuse directly, the social and educational background of patients influencing the communication in this matter and the physicians' ambivalence about their limits of responsibility were barriers often mentioned by the participants. In view of the several structural and individual barriers among gynaecologists identified in this study, gynaecologists obviously cannot be the only health professionals taking responsibility for coping with substance abuse among pregnant women. Strategies should be designed, e. g., to standardise the identification, counselling and referral process. Physicians should receive more support in improving their competences, and effective low-threshold treatment programmes for the women affected are required.