Improving the quality of antenatal screening and early intervention for alcohol and other drug use: protocol for a multi-stage approach to systems reform.

Background: Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing fetuses. Despite recommendations for abstinence during pregnancy, some women continue to use, making screening for substance use during antenatal clinic attendances an important strategy for reducing risk. This study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent. The protocol outlined here focuses on a multi-stage implementation study. Methods: This study will occur in four phases. Phase 1 will identify a baseline rate of screening and subsequent care at the antenatal clinics of two, South Australian hospital-based maternity services, through a retrospective case note audit. Rates of self-reported substance use identified in the case notes will also be compared against representative data from Adelaide Primary Health Network to establish rates of over or underreporting. Phase 2 will involve an online Training Needs Analysis of midwifery staff working at those services, to assess their knowledge, attitudes, beliefs, and commitment to the care of women who use substances during pregnancy. Phase 3 will involve a training package for all midwifery staff at those services, focused on routine screening for substance use, and how to provide appropriate care. Outcome measures from phase 2 will be reassessed during phase 3 and any changes since training will be evaluated. Phase 4 will then repeat phase 1 to compare the changes in rates of both screening and any associated intervention before and after training. Discussion: From a public health perspective, this project has the potential to make a significant impact on reducing risk of harm from substance use disorders among pregnant women, and contribute to better health outcomes for their children. Trial registration: This trial has been pre-registered under the Open Science Framework. Registration: https://doi.org/10.17605/OSF.IO/73FDZ. A note on terminology: The authors recognize that gender is a diverse, social construct encompassing a person's identity, and therefore not all individuals who give birth will identify as women, or mothers. Sex, on the other hand, often refers to biological attributes which include physical anatomy (internal and external), hormones, and chromosomal type. Given this protocol focuses on issues in which the individual's sex is central, we will refer to women who are pregnant, or women who give birth, in reference to the individual's biological sex. This decision was also taken to avoid unintended harmful consequences from using language that can be dehumanising, disembodying, and ultimately disempowering to women. [ABSTRACT FROM AUTHOR]