在孕妇中实施酒精指南的障碍和促进因素：一项针对英国助产士的横断面调查。
Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives.
机构信息
Institute of Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
出版信息
BMC Pregnancy Childbirth. 2021 Feb 15;21(1):134. doi: 10.1186/s12884-021-03583-1.
BACKGROUND
In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives' practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments.
METHODS
Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments.
RESULTS
Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1-7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking.
CONCLUSIONS
Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives' implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community.
背景
2016 年，英国首席医疗官修订了他们关于酒精的指导意见，建议女性在怀孕或计划怀孕时戒酒。助产士在怀孕期间为女性提供有关酒精的咨询方面发挥着关键作用。本研究旨在调查英国助产士在怀孕期间实施 2016 年首席医疗官酒精指南的情况，以及影响他们在产前预约时实施该指南的因素。
方法
通过专业网络和社交媒体招募的英国助产士便利样本的在线横断面调查。使用匿名在线问卷收集数据，该问卷针对的是对 2016 年《妊娠酒精指南》的了解；关于酒精评估和咨询的实践行为；以及基于理论领域框架（TDF）的问题，以评估在产前预约和随后的产前预约中建议戒酒的实施情况。
结果
在 842 名问卷回答者中，58%的人知道 2016 年的酒精指南，其中 91%（438 人）表示建议戒酒，尽管 19%（93 人）表示建议遵循之前的指南。尽管如此，842 名助产士中有 97%的人在预约时总是或通常建议女性戒酒，38%的人在随后的产前预约时建议女性戒酒。在后续预约时建议戒酒的 TDF 域平均得分（范围 1-7）最高（表示障碍）的是社会影响（3.65 sd 0.84）、对后果的信念（3.16 sd 1.13）和对能力的信念（3.03 sd 073）；而最低的（表示促进因素）是知识（1.35 sd 0.73）和专业角色和身份（1.46 sd 0.77）。逻辑回归分析表明，TDF 域：能力信念（OR=0.71，95%CI：0.57，0.88）、情绪（OR=0.78；95%CI：0.67，0.90）和专业角色和身份（OR=0.69，95%CI 0.51，0.95）是助产士在预约时建议所有女性戒酒的有力预测因素，而不仅仅是预约时。
结论
我们的结果表明，技能发展和增强同事和更广泛的产妇系统的支持，可以支持助产士在每次产前预约时提供酒精咨询，而不仅仅是在预约时，可以改善女性和婴儿的结果。从生命历程的角度来看，在产妇环境中实施酒精护理途径对妇女、儿童、家庭和更广泛的社区都有益。
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