Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

Smith, Lesley and Dyson, Judith and Watson, Julie and Scholin, Lisa (2021) Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives. BMC Pregnancy and Childbirth, 21 (134). ISSN 1471-2393

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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.

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.

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.

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.

Item Type: Article
Identification Number:
16 January 2021Accepted
15 February 2021Published Online
Uncontrolled Keywords: Prevention Implementation Behaviour change Lifecourse epidemiology Maternal health Healthcare practice
Subjects: CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-04 - midwifery
Divisions: Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR)
Depositing User: Judith Dyson
Date Deposited: 07 Oct 2021 09:57
Last Modified: 03 Mar 2022 17:15

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