TY - JOUR
T1 - A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy
T2 - Research protocol for a randomised stepped-wedge cluster trial
AU - Kingsland, Melanie
AU - Doherty, Emma
AU - Anderson, Amy E.
AU - Crooks, Kristy
AU - Tully, Belinda
AU - Tremain, Danika
AU - Tsang, Tracey W.
AU - Attia, John
AU - Wolfenden, Luke
AU - Dunlop, Adrian J.
AU - Bennett, Nicole
AU - Hunter, Mandy
AU - Ward, Sarah
AU - Reeves, Penny
AU - Symonds, Ian
AU - Rissel, Chris
AU - Azzopardi, Carol
AU - Searles, Andrew
AU - Gillham, Karen
AU - Elliott, Elizabeth J.
AU - Wiggers, John
N1 - (NHMRC) Partnership Project grant (APP1113032)
PY - 2018/8/20
Y1 - 2018/8/20
N2 - 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', 27-28weeks gestation and 35-36weeks 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.
AB - 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', 27-28weeks gestation and 35-36weeks 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.
KW - Alcohol consumption
KW - Antenatal care
KW - Clinical practice change
KW - Implementation
KW - Maternal
KW - Pregnancy
KW - Protocol
KW - Stepped-wedge trial
UR - http://www.scopus.com/inward/record.url?scp=85052131834&partnerID=8YFLogxK
U2 - 10.1186/s13012-018-0806-x
DO - 10.1186/s13012-018-0806-x
M3 - Comment/debate
C2 - 30126437
AN - SCOPUS:85052131834
VL - 13
JO - Implementation Science
JF - Implementation Science
SN - 1748-5908
IS - 1
M1 - 112
ER -