Table 4.

Refined CMOs for component 2: antenatal appointment.

Context	Mechanism	Outcome
1+2. Midwife–pregnant woman relationship at first appointment	Midwives	Midwives
3&4. Period of screening and delivery of ABIs more important as effects of drinking in first trimester is more profound	1.Use of ‘motivational interviewing style’ or good person-centred communication skills necessary to overcome unfamiliarity 2.Screening and ABIs delivered in the midst of other competing issues	1.Improved identification of risky drinking 2.Missed opportunities and declined priority
Pregnant women	Pregnant women
	1.Uneasiness about alcohol consumption disclosure at first appointment 2.Credibility of midwives adds value to their advice and facilitated change 3.Enquiry about alcohol consumption and exploration of the number, nature and size of drinks consumed prompted behaviour change 4.Early identification and intervention more critical	1.Provision of socially desirable response about drinking behaviour 2.Increased adherence to midwives’ advice 3.Women reduced or abstained from alcohol after alcohol assessment 4.More risk to the fetus reduced and subsequent maternal drinking behaviour altered