Adoption of Validated Screening Tools among Healthcare Providers in Screening for Alcohol Use among Pregnant Women and Women of Childbearing Age Open Access
Proia, Krista K (2011)
Published
Abstract
Adoption of Validated Screening Tools among Healthcare Providers
in Screening for
Alcohol Use among Pregnant Women and Women of Childbearing
Age
By Krista K. Proia
Background
Evidence-based screening recommendations have been developed
including the use
of validated screening tools and offer the most accurate way to
assess alcohol
consumption among women of childbearing age and pregnant women.
This thesis delves
further into the alcohol-use screening practices of healthcare
providers by asking not only
about the current practices they utilize but the perceived
characteristics of these practices
that influenced its adoption into practice and the barriers that
are inhibiting the adoption
of such screening tools guided by the Diffusion of
Innovations.
Methods
The current study utilized a cross-sectional online survey design
consisting of a
convenience sample of healthcare providers employed by the Emory
University
Healthcare System. Statistical analyses were conducted using SPSS
statistical package
version 18.0. Logistic regressions and independent samples t-test
analyses were computed to assess
associations between healthcare provider characteristics and
alcohol screening
characteristics.
Results
A total of 49 completed surveys were returned for a response rate
of 34%. The
majority of respondents reported always advising abstinence from
alcohol during
pregnancy. In screening women of childbearing age, the odds of
utilizing a screening
tool to assess "at-risk" drinking among respondents specializing in
obstetrics/gynecology
were decreased by a factor of 0.17 (p=0.028) and for physicians,
the odds were increased
by a factor of 10.29 (p = 0.030). In screening pregnant women, the
odds of utilizing a
screening tool to assess "at-risk" drinking for female respondents
was increased by a
factor of 12.57 (p=0.019) and for physicians the odds were
increased by a factor of 13.82
(p=0.014). There was no significant association between innovative
characteristic scores
and type of alcohol-use screening tool utilized.
Discussion
Findings from this thesis research indicates that healthcare
providers are not
consistently following the evidence-based guidelines including
utilizing a standardized
screening tool specifically validated for use in women to assess
"risk drinking".
Additional research further investigating other components of the
Diffusion of
Innovations is warranted in order to gain a better understanding of
what factors increase
the adoption rate of these screening guidelines into practice.
Table of Contents
Table of Contents
Chapter I: Introduction and Theoretical Framework
...................................................1
Introduction
..........................................................................................................................1
Current evidence-based screening recommendations
..............................................3
Diffusion of Innovations Theory
.....................................................................................6
Specific Aims and Hypotheses
......................................................................................11
Chapter II: Review of the Literature
.............................................................................13
Validated Screening Tools for Women of Childbearing Age and
Pregnant Women ........14
CAGE questionnaire
..............................................................................................14
AUDIT
questionnaire.............................................................................................15
T-ACE questionnaire
.............................................................................................16
TWEAK
questionnaire...........................................................................................17
Healthcare Provider Knowledge of Alcohol Screening Practices and
FAS/FASD .......19
Limitations of Previous Research
..................................................................................26
Chapter III: Methods
......................................................................................................27
Study Sample
.....................................................................................................................27
Recruitment
........................................................................................................................28
Data Collection Procedures
................................................................................................29
Measures
............................................................................................................................30
Demographic variables
..........................................................................................31
Current screening practices among healthcare providers
......................................32
Characteristics of the screening tool and clinic environment
................................33
Barriers inhibiting the adoption of a standardized screening tool
.........................35
Statistical Analysis
.............................................................................................................36
Aim 1: Current screening practices among healthcare providers
..........................36
Aim 2: Adoption of a validated screening tool
......................................................37
Aim 3: Barriers inhibiting the adoption of an alcohol-use screening
tool .............39
Chapter IV: Results
.........................................................................................................39
Demographics
....................................................................................................................39
Aim 1: Current Screening Practices among Healthcare Providers
....................................40
Aim 2: Adoption of a Validated Screening Tool
...............................................................47
Aim 3: Barriers Inhibiting the Adoption of an Alcohol-Use Screening
Tool ....................49
Chapter V: Discussion
.....................................................................................................50
Strengths and Limitations
..................................................................................................53
Implications for Future Research
.......................................................................................54
Conclusion
.........................................................................................................................56
References
.........................................................................................................................58
List of Appendices
Appendix I: Theoretical Framework
.................................................................................61
Appendix II: IRB Approval Letter
.....................................................................................62
List of Tables
Table 1: Demographic Characteristics of Respondents
....................................................39
Table 2: Current Screening Practices for Assessing Alcohol Use
Among Women of
Childbearing Age and Pregnant Women
...........................................................................41
Table 3: Logistic Regression Analyses Indicating an Association
Between Asking About
Personal Alcohol Use and Healthcare Provider Characteristics
........................................43
Table 4: Logistic Regression Analyses Indicating an Association
Between Advising
Abstinence During Pregnancy and Healthcare Provider Characteristics
..........................44
Table 5: Logistic Regression Analyses Indicating an Association
Between Using
Motivational Techniques and Healthcare Provider Characteristics
...................................45
Table 6: Type of Alcohol-Use Screening Tools Utilized by Healthcare
Providers ...........46
Table 7: Logistic Regression Analyses Indicating an Association
Between Utilizing an
Alcohol-Use Screening Tool and Healthcare Provider Characteristics
.............................47
Table 8: Average Innovative Characteristic Scores
...........................................................48
Table 9: Independent Samples T-Test Indicating Associations Between
Innovative
Characteristics and Utilizing a Screening Tool Validated
Specifically for Women .........48
Table 10: Logistic Regression Analyses Indicating an Association
Between Utilizing an
Alcohol-Use Screening Tool and Openness for Innovation Fostered
...............................49
Table 11: Barriers Inhibiting Healthcare Providers from Adopting an
Alcohol-Use
Screening Tool in their Practice
.........................................................................................50
About this Master's Thesis
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