Article Summary #13: Barriers to screening for alcohol and drug use

This Article Summary is part of our CanFASD Connect Top Articles Summary Series. Over the next several months, we will be bringing you summaries of all the recent research papers from our list of the Top FASD Articles of 2019. This is an overview of a research article called Barriers to screening pregnant women for alcohol or other drugs: a narrative synthesis

Background:

Alcohol and drug use during pregnancy can result in many negative outcomes for the offspring as well as the mother. Although many women stop using these substances during pregnancy, some continue their use. For example, recent research showed that among pregnant women in the United States, 11.6% continued to use alcohol and 5.1% continued to use illegal drugs.

It has been suggested that best practice for health professionals is to screen every pregnant woman for substance use using a recommended validated tool, followed by a referral to treatment and specialized support services if required. Although health care professionals in maternity care settings play a major role in screening, researchers have shown that this screening is not consistently occurring. Existing research has identified some of the barriers that women who are pregnant face when accessing prenatal care, however, very little research has been done to explore the barriers that primary care workers face when providing care.

The authors of this study conducted a review of past research to identify what health care professionals in maternity care settings perceived as barriers to screening for alcohol or drug use during pregnancy.

Main Findings:

Several barriers to screening pregnant women for alcohol or other drugs were identified including:

1. Competing priorities and time constraints: many providers prioritize other aspects of care over alcohol screening because of their workload and time constraints during prenatal care visits,
2. Lack of adequate screening skills and clear protocol for managing women who use alcohol or other drugs in pregnancy: there is a lack of skills, protocol, and resources for screening women who use alcohol or other drugs in pregnancy.
3. Relationship between health care providers and pregnant women: providers were uncomfortable in addressing maternal alcohol or other drug use, especially at the first prenatal consultation, because of a lack of rapport between them and the pregnant women.
4. Health care providers’ perceptions of alcohol or other drug use by pregnant women: common perceptions among providers were that most women did not drink much alcohol during pregnancy; pregnant women knew not to drink; and asking about alcohol could appear judgmental.
5. Under-reporting or none/ false disclosure: Health professionals in maternity care settings believed that women not truthfully disclosing the quantity of alcohol or drug use was a big barrier to effective screening and interventions.
6. Inconclusive evidence on the risk of alcohol or other drug use in pregnancy: providers had a lack of knowledge on the evidence of potential risks associated with maternal alcohol and drug use.
7. Concerns about guilt and anxiety: providers worried about the anxiety or guilt their clients may experience if they asked about alcohol or drug use.

 Recommendations:

• Encourage screening at multiple visits to identify pregnant women who may be using substances and offer support.
• Screen all women for alcohol or other drugs in general health visits to ensure an unbiased approach and potentially create a culture of empowerment and knowledge.
• Develop effective communication skills to building trusting relationships and support behavioural change, such as the use of therapeutic communication skills and motivational intervening techniques.
• On-going education and training at the primary care level is required to increase confidence in discussing alcohol or drug use in a sensitive and respectful way.
• Ensure access to appropriate assessment tools and guidelines that outline processes and protocols to help generate routine screening and intervention practices.

Authors: Helen T. Oni, Melissa Buultjens, Mohamed E. Abdel-Latif, and M. Mofizul Islam

Journal: Women and Birth

Date: December 2019

Read the full article (not available open access)