Janna Skagerström

Predictors of Drinking During Pregnancy: A Systematic Review

BACKGROUND Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. METHODS A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the womans pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e.g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. RESULTS Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were prepregnancy alcohol consumption and having been abused or exposed to violence. Less consistent predictors of drinking during pregnancy were high income/social class and positive dependence screen. Unemployment, marital status, and education level were examined in many studies but found to be predictive only infrequently. CONCLUSIONS Womens prepregnancy alcohol consumption (i.e., quantity and frequency of typical drinking) and exposure to abuse or violence were consistently associated with drinking during pregnancy. Antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.

Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden.

BackgroundThere is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.MethodsThe study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.ResultsQuestionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.ConclusionsThe prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.

Towards improved alcohol prevention in Swedish antenatal care

OBJECTIVE to evaluate an education effort and revised alcohol-preventive routine in Swedish antenatal care; to generate more knowledge for further development of alcohol issues in antenatal care. DESIGN two national cross-sectional surveys of Swedish midwives were conducted. Baseline data were collected in 2006 and follow-up data in 2009. SETTING antenatal care centres in Sweden. PARTICIPANTS 974 midwives in 2006 and 1108 midwives in 2009. MEASUREMENT amount and content of continuing professional education, work with alcohol-related issues, identification of women with risky consumption of alcohol, and action after identifying women with risky consumption. FINDINGS the amount of continuing professional education undertaken by midwives on handling risky drinking increased significantly between 2006 and 2009. The routine to detect risky drinking changed between the baseline and follow-up data collection, as nearly all midwives reported the use of an alcohol screening questionnaire in 2009. The most confident midwives in 2009 had taken part in more days of education, more often stated it was their own initiative to participate, and had more often taken part in education regarding MI, provision of advice and information on the health risks associated with alcohol and, screening. KEY CONCLUSIONS our results indicate that a broad, national education effort can be successful in enhancing knowledge and changing antenatal care practice. However, generalisation to other countries or cultures may be limited because the usage of new routines is affected by many organisational and contextual factors.

The voice of non-pregnant women on alcohol consumption during pregnancy a focus group study among women in Sweden

BackgroundConsensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.MethodsData were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.ResultsThree main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.ConclusionsSocial expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

Determinants of Patient Participation for Safer Care: A Qualitative Study of Physician's Experiences and Perceptions

There is a paucity of research on physicians’ perspectives on involving patients to achieve safer care. This study aims to explore determinants of patient participation for safer care according to physicians in Swedish health care. We used a deductive descriptive design applying qualitative content analysis based on the COM-B (Capability- Opportunity-Motivation-Behaviour) framework. Semi-structured interviews were conducted with 13 physicians in different types of health care units to achieve a heterogeneous sample. Based on the physicians’ accounts, we identified 15 determinants functioning as barriers and/or facilitators to patient participation for safer care. There were five types of determinants: physicians’ capability to involve patients in their care; patients’ capability to become involved in their care, as perceived by the physicians; physicians’ opportunity to achieve patient participation in their care; physicians’ motivation to involve patients in their care; and patients’ motivation to become involved in their care, as perceived by the physicians. There are many barriers to patient participation to achieve safer care. Although there are also facilitators, they tend to depend on initiatives of individual physicians and patients because organizational-level support may be lacking. Many of the determinants are interdependent, with physicians’ perceived time constraints influencing other barriers.

Exploring experiences among adopters during the diffusion of a novel dance intervention in Sweden

ABSTRACT There is a demand for interventions aimed at adolescent girls with psychosomatic problems. In 2013, positive results were reported from a dance intervention programme addressing girls with internalizing problems. The research team behind the intervention immediately received requests from municipalities and county councils interested in using the intervention. From an implementation point of view it is unclear what made the intervention spread without an active plan. The aim of this study was to explore adopters’ experiences about the diffusion and initiation of a public health intervention targeting adolescent girls with internalizing problems. Interviews were conducted with 12 people who were engaged in initiating the intervention in different settings. Data were analysed using conventional content analysis, yielding three categories: perceived appeal and trustworthiness, convenient information, and contextual factors. The results reflected that the participants found that there was a need for an intervention and found the dance intervention to be evidence based and not too complex to perform. Further, there was available information on the project which could easily be distributed to decision makers and others. When initiating the intervention, factors related to economy, possibility for collaboration and recruitment were of importance.

Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experiences

To explore nurses’ perceptions and experiences of patient involvement relevant to patient safety.