Title: CHAMPION - AlCohol HArM PreventIOn iN pregnancy
Funder: Department of Health and Social Care

Abstract: Research question: What are the components of an implementation intervention to support midwives provision of recommended care addressing alcohol consumption with women attending antenatal appointments; is such an intervention feasible to implement in practice; and is it acceptable to service providers and service users? Background Alcohol is a major risk factor for chronic diseases in the UK. Peri-conception and pregnancy alcohol exposure is a risk factor for miscarriage, premature birth, intra-uterine growth restriction and Fetal Alcohol Spectrum Disorders - estimated to cost &pound;2 billion/year. The NE Local Maternity System boards have prioritised reducing alcohol harms during pregnancy. Evidence shows that alcohol screening and intervention in antenatal settings is effective in helping women reduce their alcohol consumption and is recommended by the World Health Organisation. Barriers to implementation of alcohol assessment, advice and/or appropriate referral by midwives need to be addressed in order to facilitate practices in this important area of prevention. Aims and objectives: To co-design a theoretically informed intervention to support midwives in assessing and recording a woman's alcohol consumption, followed by appropriate advice and/or onward referral at antenatal appointments To evaluate the feasibility of implementing such an intervention in practice; and acceptability of intervention delivery and content to maternity service users and providers. Methods Workpackage 1: Co-design intervention development 1a) intervention mapping exercise to select Behaviour Change Techniques to underpin the intervention. 1b) Two co-production workshops with research team members and key stakeholders (6-8 midwives, 2-3 substance misuse specialist midwives, and 4&ndash;6 maternity service users) where findings from the first will be presented and feedback sought at the second, then intervention refined until final content is agreed. Expected outputs are a working prototype of an intervention, an intervention manual and all associated resources required for intervention delivery. Workpackage 2: &ndash; Intervention refinement 2a) Expert review of intervention manual content and associated resources by key stakeholders (service managers, midwives, and representatives from professional organisations such as the Royal College of Midwives) for feedback. 2b) Early feasibility and acceptability of the implementation intervention evaluated in two NHS Trusts through: in-depth interviews to gather experiences of the intervention, perceived utility and impact on practice (midwives ); and receiving alcohol questions and advice at antenatal appointments (womens ). Audit of hand-held and electronic patient records for recording of alcohol assessment and advice. Timelines for delivery Study duration: 17 months - months 0-4 - study set-up; months 4-10 &ndash; workpackage 1; months 10-15 workpackage 2; 15-17 close and write up Anticipated impact and dissemination Feasibility data to inform planning of a future pilot and definitive RCT which if proven to be effective and cost-effective could benefit women by facilitating informed choice; and reducing alcohol-related harm to maternal and infant health.

Lay abstract: Drinking too much alcohol can damage a woman s health. There is more chance that she might develop a serious illness such as breast cancer, liver or heart disease. If a woman drinks alcohol during pregnancy, this can also harm her baby. Sometimes this can lead to Fetal Alcohol Syndrome. This is the name for all the problems that can affect a child if their mother drinks in pregnancy. These problems are lifelong and can affect a child s growth and development, including their physical and mental health, their behaviour and their ability to learn. Up to 17 in 100 children in England might have symptoms of this disorder. National guidelines advise midwives to: ask pregnant women how much they drink; advise women not to drink alcohol when pregnant; and help women to access specialist support for alcohol problems. However our recent research shows that not all midwives have this conversation at routine antenatal appointments. We identified some of the main reasons why this is not happening. We want to work closely with midwives, women who use maternity services and their families, to look at how to overcome these barriers. We want to develop ways to better support midwives, for example, training and resources to develop their skills and confidence. The voices of women and children affected by this disorder will be central to this. We will test how effective this approach is in practice in two different NHS trusts over a period of 3 months. We want to find out: if it helps midwives to talk about this topic with women; if midwives, pregnant women and their families find it acceptable; and if it supports women to make an informed choice. If the results of this study are promising, then we will test this in a larger number of NHS trusts. If this is successful, we want this to be available across the NHS. We have asked maternity and public health service providers, midwives, alcohol and pregnancy and childbirth charities, and users of maternity services to help us identify how to improve this situation. We have used their feedback to design this study.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH