Table 2.
Proposed CMO configurations for screening and ABIs.
| Theory area | Context | Mechanism | Outcome |
|---|---|---|---|
| Uncertainties of risk | There are still uncertainties of risk to the fetus regarding the effects of lower levels of alcohol consumption | 1. Midwives and pregnant women’s attitudes to risk of drinking in pregnancy may facilitate or act as barriers to change | 1. Positive attitudes may facilitate screening and ABI delivery and negative attitudes may have contrary effect. |
| 2. Opportunity for midwives to address issues of uncertainties bothering women. | 2. Increased opportunity to offer consistent advice to high risk women | ||
| Antenatal appointment | 1. Midwife-pregnant woman relationship at first appointment | 1a. Midwives use of ‘motivational interviewing style’ or good person-centred communication skills necessary | 1a. Improved identification of risky drinking |
| 1b. Negotiate competing priorities at first appointment | 1b +c. Quality of screening and ABIs negatively affected. | ||
| 1c. Amount of information provided to women | |||
| 2. ‘Captive’ audience and most women are motivated to change drinking behaviour | 2a. Women respected and valued midwives’ role | 2a. Increased possibility of drinking behaviour change | |
| 2b. Enquiry about alcohol use prompt behaviour change | 2b. Increased identification of risky drinkers | ||
| 3. Period of screening and delivery of ABIs more important as effects of drinking in first trimester is more profound | 3. Early identification and intervention more critical | 3. Women more likely to change drinking behaviour early | |
| Training and support | Screening and alcohol brief interventions skills training | 1. Midwives empowered with skills to change women’s drinking behaviour | 1. Improved skills and confidence to identify and deliver ABIs |
| 2. Resistance to change | 2. Overcome resistance | ||
| 3. Provision of additional support and resources by implementing authority | 3. Raised awareness of risk of antenatal drinking and ABI programme | ||
| Few women consuming alcohol meant few ABIs delivered | ABI delivery skills rarely used | Decreased in importance of ABI related activities | |