Adoption of Validated Screening Tools among Healthcare Providers in Screening for Alcohol Use among Pregnant Women and Women of Childbearing Age 公开

Proia, Krista K (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/nk322d76k?locale=zh
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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







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